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Mother-to-Child Transmission of HIV-2: The French ANRS Perinatal Cohort EPF-CO1/11
C Jasseron1, M Burgard2,3, J P Teglas4, S Matheron5, F Damond5, K Hamrene1, S Blanche2,3, C Rouzioux2,3, J Warszawski4,6, Laurent Mandelbrot*7,8, and The ANRS French Perinatal Cohort EPF
1Hosp Bicetre, Le Kremlin-Bicetre, France; 2Hosp Necker, Paris, France; 3Univ Paris 5, France; 4INSERM U822, Le Kremlin Bicetre, France; 5Hosp Bichat, Paris, France; 6Univ Paris Sud, Le Kremlin-Bicetre, France; 7Univ Paris 7 Diderot, Paris, France; and 8Hosp Louis Mourier, Colombes, France
Background: Management of pregnancies with
HIV-2 infection remains unclear because of important differences with HIV-1, in terms of natural history and resistance to NNRTI, and because of its lower prevalence.
Methods: All pregnant women infected by HIV-2 alone, enrolled
from 1986 to 2004 in the French Perinatal HIV Cohort, and their children, were
eligible for this analysis. Plasma HIV-2 viral load near delivery was
quantified with HIV-2 RNA real time polymerase chain reaction (RT-PCR) (cut-off
2.3 log copies/mL) and HIV-2 infection child status was determined using HIV-2
DNA PCR ± culture and serology after 18 months of age.
Results: Of 7478 mothers enrolled in EPF, 191 (2.6%) were HIV-2
infected, most of them born
in Sub-Saharan Africa (92%). The total number of pregnancies during the
study period was 313 of 9727 (3.2% of the cohort). Among these pregnancies, 94%
were in women defined as Centers of Disease Control and Prevention (CDC) group
A; CD4 count at delivery was >350/µL in 80%, and <200/µL in only 7.6%. ART
was prescribed in 162 pregnancies (52.6%): zidovudine (ZDV) monotherapy in
69.8%, dual NTRI in 15.4%, and triple therapy with a protease inhibitor (PI) in
14.8%. In most cases, the objective was prevention of mother-to-child
transmission (PMTCT). In 146 pregnancies (47.4%), the mothers received no ART
(80.8% of them before 1997), including 4 whose CD4 was <200/µL. Intrapartum
ZDV was administered in 53.9% of mothers, and 17.4% of deliveries were elective
cesarean; 51.9% of neonates received postnatal prophylaxis with ZDV. In 21.3% of treated mothers with available
viral load, HIV-2 RNA remained detectable at delivery (median 3.3 log
copies/mL). Among the 320 children (including twins), 2 were HIV-2
infected, a transmission rate of 0.6% (95%CI 0.08% to 2.2%). The first
case occurred in 1993, in a mother who had untreated HIV-2 primary infection.
The second case occurred in 2002, in a mother inappropriately given a triple therapy with nevirapine; CD4 count was 67/µL and HIV-2
RNA 2.9 log copies/mL at delivery.
Conclusions: These findings support current French guidelines
for PMTCT, i.e. to use minimal ART (ZDV) in women whose CD4 >350/µL,
and triple ART with PI in women with lower CD4 counts, to reduce the risk of
transmission and to treat the mother’s HIV-2 disease.
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