TY - JOUR
T1 - Risk for perinatal HIV-1 transmission according to maternal immunologic, virologic, and placental factors
AU - St.Louis, ME
AU - Kamenga, M
AU - Brown, C
AU - Nelson, AM
AU - Manzila, T
AU - Batter, V
AU - Behets, F
AU - Kabagabo, U
AU - Ryder, RW
AU - Oxtoby, M
AU - Quinn, TC
AU - Heyward, WL
PY - 1993
Y1 - 1993
N2 - OBJECTIVE--To evaluate how maternal and obstetric factors interact to influence mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission. DESIGN--Prospective, observational cohort study of children born to HIV-infected women to determine child's HIV infection status. The analysis then compared peripartum maternal, placental, and obstetric variables between HIV-1 transmitter and nontransmitter women. SETTING--Two large maternity wards in Kinshasa, Zaire. PARTICIPANTS--Consecutive sample of 324 HIV-1-infected women at delivery, with 254 HIV-seronegative women followed up as control subjects. PRINCIPAL OUTCOME MEASURES--HIV infection status of children, to classify each woman as an HIV-1 transmitter or nontransmitter. RESULTS--The highest transmission risk (TR) was associated with maternal p24 antigenemia (TR, 71%; relative risk [RR], 3.0; 95% confidence interval [CI], 1.7 to 5.2) and maternal CD8+ lymphocyte counts of at least 1.80 x 10(9)/L (1800/microL) (TR, 50%; RR, 2.2; 95% CI, 1.2 to 4.2). Among women with CD8+ lymphocyte counts of less than 1.80 x 10(9)/L, CD4+ lymphocyte counts of less than 0.60 x 10(9)/L were a risk factor (TR, 29%; RR, 2.2; 95% CI, 1.2 to 4.2). In women with neither high CD8+ nor low CD4+ lymphocyte counts, placental membrane inflammation was associated with perinatal transmission (TR, 40%; RR, 4.2; 95% CI, 1.3 to 13.7). In women with neither p24 antigenemia, high CD8+ or low CD4+ lymphocyte counts, nor placental membrane inflammation, the transmission risk was only 7%. Additional correlates of transmission included maternal anemia and fever, but not maternal sexually transmitted diseases. CONCLUSIONS--Identifiable subgroups of HIV-1-infected women based on maternal and placental characteristics had between a 7% and 71% risk of perinatal HIV-1 transmission. Not only the overall rate of transmission but the impact of different risk factors for transmission appear to vary over the course of HIV infection
AB - OBJECTIVE--To evaluate how maternal and obstetric factors interact to influence mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission. DESIGN--Prospective, observational cohort study of children born to HIV-infected women to determine child's HIV infection status. The analysis then compared peripartum maternal, placental, and obstetric variables between HIV-1 transmitter and nontransmitter women. SETTING--Two large maternity wards in Kinshasa, Zaire. PARTICIPANTS--Consecutive sample of 324 HIV-1-infected women at delivery, with 254 HIV-seronegative women followed up as control subjects. PRINCIPAL OUTCOME MEASURES--HIV infection status of children, to classify each woman as an HIV-1 transmitter or nontransmitter. RESULTS--The highest transmission risk (TR) was associated with maternal p24 antigenemia (TR, 71%; relative risk [RR], 3.0; 95% confidence interval [CI], 1.7 to 5.2) and maternal CD8+ lymphocyte counts of at least 1.80 x 10(9)/L (1800/microL) (TR, 50%; RR, 2.2; 95% CI, 1.2 to 4.2). Among women with CD8+ lymphocyte counts of less than 1.80 x 10(9)/L, CD4+ lymphocyte counts of less than 0.60 x 10(9)/L were a risk factor (TR, 29%; RR, 2.2; 95% CI, 1.2 to 4.2). In women with neither high CD8+ nor low CD4+ lymphocyte counts, placental membrane inflammation was associated with perinatal transmission (TR, 40%; RR, 4.2; 95% CI, 1.3 to 13.7). In women with neither p24 antigenemia, high CD8+ or low CD4+ lymphocyte counts, nor placental membrane inflammation, the transmission risk was only 7%. Additional correlates of transmission included maternal anemia and fever, but not maternal sexually transmitted diseases. CONCLUSIONS--Identifiable subgroups of HIV-1-infected women based on maternal and placental characteristics had between a 7% and 71% risk of perinatal HIV-1 transmission. Not only the overall rate of transmission but the impact of different risk factors for transmission appear to vary over the course of HIV infection
KW - B780-tropical-medicine
KW - Viral diseases
KW - HIV-1
KW - AIDS
KW - Disease transmission-vertical
KW - Mother-to-child
KW - Risk
KW - Maternal factors
KW - Pregnancy
KW - Obstetrics
KW - Complications
KW - Congo-Kinshasa
KW - Kinshasa
KW - Africa-Central
M3 - A1: Web of Science-article
VL - 269
SP - 2853
EP - 2859
JO - Journal of the American Medical Association
JF - Journal of the American Medical Association
SN - 0098-7484
ER -