654
Amniocentesis and Mother-to-Child HIV Transmission: The French ANRS EPF Cohort CO1/11
Laurent Mandelbrot*1,2,3, C Jasseron4, D Ekoukou5, A Batallan6, A Bongain7, E Pannier8, S Blanche9,10, R Tubiana11, C Rouzioux9,10, J Warszawski3,4,12, and The ANRS French Perinatal Cohort EPF
1Hosp Louis Mourier, Colombes, France; 2Univ Paris 7 Diderot, Paris, France; 3INSERM U822, Le Kremlin Bicetre, France; 4Hosp Bicetre, Le Kremlin-Bicetre, France; 5Hosp Delafontaine, St Denis, France; 6Hosp Bichat, Paris, France; 7Hosp L`Archet 2, Nice, France; 8Hosp Cochin, Paris, France; 9Hosp Necker, Paris, France; 10Univ Paris 5, France; 11Hosp Pitie-Salpetriere, Paris, France; and 12Univ Paris Sud, Le Kremlin-Bicetre, France
Background: We studied
whether performing an amniocentesis in patients infected with HIV-1 was
associated with an increased risk of mother-to-child transmission (MTCT).
Methods: The study was performed in the ongoing
multi-center French Perinatal HIV Cohort, among HIV-1-infected women enrolled
from 1984 to 2006 delivering at 28 weeks or more. We excluded multiple
pregnancies. Specific data on whether amniocentesis had been performed was
available for a total of 8272 pregnancies. Only live-born singleton children
were included in the analysis of MTCT.
Results: The proportion of pregnancies in which an
amniocentesis had been performed increased from 1.0% (58 of 5831) in the period
before 2001 to 2.7% (67 of 2441) in 2001 to 2006. Women who had had an amniocentesis
were more often treated with combination ART than women who had not had an
amniocentesis (39.6% vs 23.4% p <0.0001), and had a non-significant
trend to higher CD4 cell counts. They also had a significantly higher
proportion of planned cesarean section and premature delivery. There was a trend
towards a higher MTCT rate, though not statistically significant, in mothers
who had had an amniocentesis, compared with the others, among women who had not
received any ART (25.0% [3 of 12] vs 16.3% [343 of 2104]; p = 0.43), and
among mothers who received zidovudine monotherapy or a double NRTI combination
(6.5% [3 of 46] vs 3.3% [115 of 3485]; p = 0.20). For mothers who
received HAART (at least 3 drugs), there was no difference in MTCT rate (0.0% [0
of 38], 95%CI 0.0% to 8.8% vs 1.4% [23 of 1613], 95%CI 0.9% to 2.1%; p =
1.0). In most cases (75%), HAART were started before the amniocentesis.
Conclusions: Our results suggest that amniocentesis does
not increase the risk of MTCT of HIV if the mother is treated with an effective
ART.
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