841
The Role of Elective Cesarean Section in HIV/HCV-co-infected Mothers in the HAART Era
Claudia Fortuny*1, E Sanchez2, A Noguera1, M Muñoz Almagro1, G Claret1, M Marco1, C Moreno1, and J Pou1
1Hosp Sant Joan de Déu, Esplugues, Barcelona, Spain and 2Catalan Agency for Hlth Tech Assessment and Res, Barcelona, Spain
Background: In Catalonia
(Spain),
hepatitis C virus (HCV) co-infection is very common (60%) among HIV-infected pregnant
women. Risk of HCV mother-to-child transmission (MTCT) increases in HIV/HCV-co-infected
mothers. In the prevention of HIV MTCT, elective cesarean section and HAART
have resulted in dramatic decreases in the rates of such infection. We hypothesized
that elective cesarean section and HAART also have a role in preventing HCV
MTCT in HIV/HCV-co-infected mothers.
Methods: Prospective observational study
on a cohort of infants born to HCV/HIV-co-infected mothers in Barcelona from January 1987 to December 2004.
HCV infection was diagnosed when anti-HCV antibodies persisted beyond 18 months
of age or by HCV RNA detection since 1993. Crude and adjusted relative risks
(RR) and 95% confidence intervals were estimated.
Results: The study included 282 children
(47.5% females), born to 279 mothers (13 sets of twins). The table shows the
selected risk factors and their association with HCV transmission:
|
|
n
|
HCV infected (%)
|
RR (95% CI)
|
p
|
|
Transmission group
IDU
Heterosexual
|
265
17
|
31 (11.7%)
2 (11.8%)
|
0.99 (0.26 - 3.81)
|
0.993
|
|
ART during gestation
None
Mono- or bi-therapy
HAART
|
161
51
70
|
22 (13.7%)
5 (9.8%)
6 (8.6%)
|
0.72 (0.29 - 1.80)
0.63 (0.27 - 1.48)
|
0.472
0.277
|
|
Mode of delivery
Elective cesarean section
Vaginal or urgent cesarean section
|
87
195
|
4 (4.6%)
29 (14.9%)
|
0.31 (0.11 - 0.85)
|
0.013
|
|
Elective cesarean section adjusted by HAART
|
|
|
0.48 (0.23 - 1.01)
|
0.059
|
|
Gestational age
<37 weeks (prematurity)
≥37 weeks
|
84
198
|
5 (5.9%)
28 (14.1%)
|
0.42 (0.17 - 1.05)
|
0.051
|
|
Birth weight
<2500 g
≥2500 g
|
90
192
|
9 (10.0%)
24 (12.5%)
|
0.80 (0.39 - 1.65)
|
0.543
|
|
Birth weight adjusted by
gestational age
|
|
|
0.65 (0.35 - 1,24)
|
0.248
|
|
HIV infection
Yes
No
|
26
256
|
9 (34.6%)
24 (9.4%)
|
3.69 (1.93 - 7.08)
|
0.001
|
|
TOTAL
|
282
|
33 (11.7%)
|
|
|
Conclusions: In our setting, elective cesarean
section seems to have a protective role in HCV MTCT in HIV/HCV-co-infected
mothers, even after adjusting by HAART use during pregnancy. HAART alone is not
associated to the prevention of HCV transmission. The main risk factor is HIV
co-infection.
|
