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Duration of Ruptured Membranes and Vertical Transmission of HIV-1: A Meta-Analysis from Fifteen Prospective Cohort Studies J. READ* for the Intl. Perinatal HIV Group.
NICHD, Bethesda, MD Background: The relationship between duration of ruptured membranes (DROM) and vertical transmission (VT) of HIV-1 was evaluated in a meta-analysis using individual patient data from prospective cohort studies.
Methods: Studies including at least 100 mother-child pairs, from regions where women with HIV-1 are counseled not to breastfeed, were eligible for inclusion. The primary analysis included deliveries with DROM < 24 hours, either vaginal deliveries (VagD) or cesarean sections performed after rupture of membranes and/or after onset of labor (NECS). Multi-variate logistic regression analysis was used to assess the strength of the relationship, adjusting for other factors associated with VT.
Results: Data for 4721 mother-child pairs from 5 European and 10 North American studies were analyzed. After adjusting for mode of delivery, receipt of antiretroviral therapy, maternal disease stage, and infant birth weight, the likelihood of VT increased linearly with increasing DROM [adjusted odds ratio = 1.02 (95 percent confidence interval: 1.01, 1.04) for each one hour increment]. There were no significant interactions of DROM with study cohort or with any of the covariates, except maternal AIDS. Of note, mode of delivery (VagD or NECS) did not modify the relationship between DROM and VT. With AIDS, the probability of VT increased in a curvilinear fashion from 8% to 31% with DROM of two hours and 24 hours, respectively (p < 0.01).
Conclusions: These results confirm that DROM affects the risk of VT of HlV-1, and suggest a diagnosis of AIDS in the mother at the time of delivery may potentiate the effect of DROM.
Key Words: duration of ruptured membranes, vertical transmission
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