Vertical transmission of HIV-1: maternal immune status and obstetric factors. The European Collaborative Study.
AIDS
; 10(14): 1675-81, 1996 Dec.
Article
em En
| MEDLINE
| ID: mdl-8970688
ABSTRACT
OBJECTIVE:
To estimate the effect of maternal factors and events around the time of delivery on HIV-1 vertical transmission risk.DESIGN:
Prospective study.SETTING:
Twenty-two obstetric and paediatric clinics in seven European countries. PATIENTS OR OTHERPARTICIPANTS:
Mothers identified as HIV-infected before or at delivery and their children. MAIN OUTCOMEMEASURE:
Paediatric HIV infection.RESULTS:
By November 1995, 1846 mothers with 1945 children had been enrolled. The vertical transmission rate was 16.4% (95% confidence interval, 14.5-18.3). Parity, maternal age, race, mode of HIV acquisition, injecting drug use and sex of infant were not statistically significantly associated with risk of transmission. Children delivered vaginally were more likely to be infected than those delivered by Caesarean section. However, in vaginal deliveries the procedures used, duration of ruptured membranes or length of second-stage labour were not related to transmission. Transmission increased almost linearly with decreasing CD4 cell count, but there was no such trend for CD8 cell count. Women with CD4 cell counts below 200 x 10(6)/l were significantly more likely to deliver early (chi 2 for trend, 14.02; P < 0.001). Very premature infants were at increased risk of infection, but after about 35 weeks gestation the transmission rate remained stable, with no increase in late pregnancy. This trend was confirmed after allowing for maternal CD4 cell count.CONCLUSIONS:
The rate of vertical transmission increases linearly with decreasing maternal CD4 cell count. Women with fewer than 200 x 10(6) CD4 cells/l have an increased risk of premature delivery, which would affect timing of interventions. The stable transmission rate after 35 weeks gestation suggests little acquisition of infection during late pregnancy.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Infecções por HIV
/
HIV-1
/
Exposição Materna
/
Transmissão Vertical de Doenças Infecciosas
Tipo de estudo:
Clinical_trials
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Female
/
Humans
/
Newborn
/
Pregnancy
País/Região como assunto:
Europa
Idioma:
En
Revista:
AIDS
Assunto da revista:
SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS)
Ano de publicação:
1996
Tipo de documento:
Article
País de afiliação:
Reino Unido