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Session 26 Oral Abstract Session
Pediatric/Maternal-Fetal HIV Infection and Issues in HIV-Infected Women
Session Time: Wednesday, 10 am - 12:30 pm
Room 606-609

10:45   114.
 Mother-to-Child HIV Transmission Rates According to Antiretroviral Therapy, Mode of Delivery, and Viral Load (PACTG 367)
D. Shapiro*1, R. Tuomala2, R. Samelson3, S. Burchett4, G. Ciupak5, J. McNamara6, H. Pollack7, and J. Read8
1Harvard Sch. Publ. Hlth., Boston, MA; 2Brigham & Women's Hosp., Boston, MA; 3Albany Med. Ctr., NY; 4Children's Hosp., Harvard Med. Sch., Boston, MA; 5FSTRF, Inc., Buffalo, NY; 6NIAID, NIH, Bethesda MD; 7New York Univ. Med. Sch., New York; and 8NICHD, NIH, Bethesda, MD

Background: Antiretroviral therapy (ART) during pregnancy and elective cesarean section before labor and membrane rupture (ECS) each reduce vertical HIV transmission, but their effects according to maternal viral load are not well characterized.

Methods: Planned analysis of ongoing abstraction of medical records of HIV-infected pregnant women at 67 U.S. clinical sites (PACTG 367). Data on pregnancies resulting in live birth(s) between January 1998 and August 2000 with known infant HIV status were analyzed. χ2 and Fisher Exact test p-values and exact binomial 95% confidence intervals (CI) were calculated.

Results: Infant HIV infection status was known for 2087 pregnancies. 76 infants were infected with HIV (overall transmission rate [TR]: 3.6%; 95% CI: [2.9-4.5%]). Over time, TR decreased (1998: 4.3%; 1999: 4.1%; 2000: 1.6%; p=0.03), along with increases in third trimester multi-agent ART use (1998: 74%; 1999: 78%; 2000: 86%; p<.001) and ECS (1998: 12%; 1999: 29%; 2000: 29%; p<0.001). TR (95% CI) according to third trimester ART, mode of delivery, and last antenatal plasma HIV RNA level (measured at median 34 weeks gestation) were:

 (*† indicate p<0.05)

Last Antenatal HIV RNA, copies/mL [n]

Overall

3rd Trimester ART [N]

<103 [1141]

103-104 [445]

>104 [298]

[2087]

 None/Unknown [152]

0 (0-15)

4.2 (.1-21)

11.8 (2-36)

*20 (14-28)

 Single Agent     [303]

1.8 (.2-6)

3.1 (.6-9)

11.8 (4-24)

*5.3 (3-8)

 Multi-Agent    [1632]

.8 (.3-2)

2.2 (.9-4)

4.8 (2-8)

*1.8 (1-2.5)

Mode of Delivery

 

 

 

 

 Vaginal            [1275]

.8 (.3-2)

2.2 (.8-5)

7.0 (3.5-12)

4.2 (3-5)

  ECS                  [465]

.8 (.1-3)

3.6 (1-9)

5.0 (1-12)

2.6 (1-4.5)

  Other CS          [347]

1.1 (.1-4)

1.6 (0-8)

7.0 (2-17)

3.3 (2-6)

Overall            [2087]

.9 (.4-2)

2.5 (1-4)

6.4 (4-10)

3.6 (3-4.5)

Conclusions:  Over time, transmission rates decreased and multi-agent ART use and ECS increased. TR were significantly lower with more intensive ART and lower plasma HIV RNA level, but did not differ according to delivery mode. Among women with last antenatal RNA <1000 copies/mL, TR were low across ART types and delivery modes.

©2002 9th Conference on Retroviruses and Opportunistic Infections