HIV mother-to-child transmission according to prophylactic chemotherapy, delivery practice and breastfeeding
Keywords:
VERTICAL TRANSMISSION OF DISEASE, HIV INFECTIONS, CHEMOPREVENTION, ANTI-HIV AGENTSAbstract
HIV positive mothers and their children born between 1st January 1995 and 30th June 2000 were studied.
Objective. To analyze HIV mother-to-child transmission related to prophylactic therapy, delivery mode and breastfeeding.
Methods. Children were categorized as infected, serum-reverted or exposed.
Three groups were established: A) without prophylactic therapy, B) zidovudine (ZDV) during pregnancy, labor or cesarean and newborn of at least 42 days old, C) more than one antiretroviral drug during pregnancy and ZDV in labor or cesarean, and newborn of at least 42 days old.
Infants were considered as breastfed if they had been receiving mother-milk during more than one week. Delivery modes such as labor, elective cesarean or emergency cesarean were analyzed.
Birth weight, gestational age and quantity of pregnancies.
Results. In the group A eighty-two mother-child pairs were enrolled in the study, of which they were 41 infected infants (50%). Breastfed infants accounted for 42% (34 infants). In relation to delivery mode, vaginal was seen in 58 mothers (70%) and elective cesarean for 7. The group B was composed by 101 mother-child pairs with 5 infected infants (5%). Two infants were breastfed. Vaginal delivery was seen in 62 patients (61%) and there were 29 cesarean of choice (29%), and the group C by 34 pairs of whom 34 infants were serum-reverted, 33 were not breastfed, no data in the other case. Elective cesarean accounted for 26,5%.
There were no differences between the three groups on weight, pregnancy age, mother's age or quantity of pregnancies.
Conclusions. HIV mother-to-child transmission frankly decrease with antiretroviral treatment. Increase in elective cesarean and no breastfeeding are associated with this condition.
References
2) Center of Disease Control (CDC). Recomendations of the U.S. Public Health Service Task Force on the use of Zidovudine to reduce perinatal transmission of HIV. MMWR (Mob Mortal Wkly Rep) 1994; 43, RR-11, 1-18.
3) Aleixo LF, Goodenow MM, Sleasman JW. Zidovudine administered to women infected with HIV type 1 and to their neonates reduces pediatric infection independent of an effect on levels of maternal virus. J Pediatr 1997; 130(6): 906-14.
4) Mayaux MJ, Dussaix E, Isopet J, Rekacewicz C, Mandelbrot L, Ciraru-Vigneron N, et al. Maternal virus load during pregnancy and mother-to-child transmission of HIV type 1: the French perinatal cohort studies. J Infect Dis 1997; 175(1): 172-5.
5) Sperling RS, Shapiro DE, Coombs RW, Todd JA, Herman SA, McSherry GD, et al. Maternal viral load, zidovudine treatment, and risk of transmission of HIV type 1 from mother to infant. Pediatric AIDS Clinical Trial Group Protocol 076 Study Group. N Engl J Med 1996; 335(22): 1621-9.
6) Carpenter CC, Fischl MA, Hammer SM, Hirsch MS, Jacobsen DM, Katzenstein DA, et al. Antiretroviral therapy of HIV infection in 1997. Update recommendations of the International AIDS Society - USA panel. JAMA 1997; 277(24): 1962-9.
7) Center of Disease Control (CDC). Public Health Service Task Force recommendations for the use of antiretroviral drugs in pregnant women infected with HIV-1 for maternal health and for reducing perinatal HIV-1 transmmission in the United States. MMWR (Mob Mortal Wkly Rep) 1998; 47 (RR-2): 1-29.
8) Mc Gowan J, Crane M, Wiznia A, Blum S. Combination antiretroviral therapy in HIV-infected pregnant women. Obstet Gynecol 1999; 94(5 Pt 1): 641-6.
9) Mandelbrot L, Landreau-Mascaró A, Reckacewicz C, Berrebi A, Bénifla J, Burgard M, et al. Lamivudine-zidovudine combination for prevention of maternal-infant transmission of HIV-1. JAMA 2001; 285(16): 2083-93.
10) Nicoll A, Newell ML, Peckham C, Luo C, Savage F. Infant feeding and HIV-1 infection. AIDS 2000; 14(suppl.3): S57-S74.
11) European Collaborative Study. Caesarean section and risk of vertical transmission of HIV 1 infection. Lancet 1994; 343(8911): 1464-67.
12) Quian J, Picón T, Rodríguez I, Gutiérrez S, González A, Nin M, et al. Evaluación de la quimioprofilaxis con zidovudine a la mujer embarazada VIH+ y su hijo. Rev Enf Infec Ped 2000; 13(52): 377-82.
13) Center of Disease Control (CDC). 1994 Revised Classification System for HIV infection in children less than 13 years of age. MMWR 1994; RR- 12, 1-13.
14) Gibb D, Tess B. Interventions to reduce mother-to-child transmission of HIV infection: new developments and current controversies. AIDS 1999; 13(suppl. A): S93- S102.
15) European collaborative study. HIV infected pregnant women and vertical transmission in Europe since 1986. AIDS 2001; 15(6): 761-70.
16) Frenkel LM, Wagner LE 2nd, Demeter LM, Dewhurst S, Coombs R, Murante BL, et al. Effects of zidovudine use during pregnancy on resistance and vertical transmission of HIV Type 1. Clin Infect Dis 1995; 20(5): 1321-6.
17) Quian J, Picón T, Rodríguez I, Gutiérrez S, González A, Nin M, et al. Evaluación de la quimioprofilaxis con zidovudine a la mujer embarazada VIH (+) y su hijo. Arch Pediatr Uruguay 1999; 70(1): 5-10.
18) Ryder RW, Nsa W, Hassig SE, Behets F, Rayfield M, Ekungola B, et al. Perinatal transmission of the HIV type 1 to infants of seropositive women in Zaire. N Eng J Med 1989; 320(25): 1637-42.
19) Adjorlolo-Johnson G, De Cock KM, Ekpini E, Vetter KM, Sibailly T, Brattegaard K, et al. Prospective comparison of mother-to-child transmission of HIV-1 and HIV-2 in Abidjan, Ivory Coast. JAMA 1994; 272(6): 462-73.
20) Ruff A, Halsey N, Coberly J, Boulos R. Breast-feeding and maternal-infant transmission of HIV type 1. J Pediatr 1992; 121(2): 325-9.
21) Quian J, Picón T. VIH-SIDA en pediatría. Arch Pediatr Uruguay 1990; 61: 71-4.
22) Martin R, Boyer P, Hammill H, Peavy H, Platzker A, Settlage R, et al. Incidence of premature birth and neonatal respiratory disease in infants of HIV-positive mothers. The Pediatric Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV Study Group. J Pediatr 1997; 131(6): 851-6.
23) Lambert JS, Watts DH, Mofenson L, Stiehm ER, Harris DR, Bethel J, et al. Risk factors for preterm birth, low birth weight, and intrauterine growth retardation in infants born to HIV-infected pregnant women receiving zidovudine. AIDS 2000:14(10): 1389-99.
24) Blanche S, Rouzioux C, Moscato ML, Veber F, Mayaux MJ, Jacomet C, et al. A prospective study of infants born to women seropositive for HIV type 1. N Engl J Med 1989; 320(5): 1643-8.
25) European Collaborative Study. Risk factors for mother-to-child transmission of HIV 1. Lancet 1992; 339(8800): 1007-12.
26) Duliege AM, Amos CI, Felton S, Biggar RJ, Goedert JJ. The International Registry of HIV-Exposed Twins. Birth order, delivery route, and concordance in the transmission of HIV type 1 from mothers to twins. J Pediatr 1995; 126(4): 625-32.
27) The International Perinatal HIV Group. The mode of delivery and the risk of vertical transmission of HIV type 1. A meta-analysis of 15 prospective cohort studies. N Engl J Med 1999; 340(13): 977-87.
28) The European collaborative study. Maternal viral load and vertical transmission of HIV-1: an important factor but not the only one. AIDS 1999; 13(11): 1377-85.
29) The European mode of delivery collaboration. Elective caesarean-section versus vaginal delivery in prevention of vertical HIV-1 transmission: a randomised clinical trial. Lancet 1999; 353(9158): 1035-9.
