Factors predictive of maternal-fetal transmission of HIV-1. Preliminary analysis of zidovudine given during pregnancy and/or delivery

Boyer, Pamela; Dillon, M J; Navaie, Maryam; Deveikis, Audra; Keller, ML; O’Rourke, Stephen T.; Bryson, Yvonne J.

doi:10.1001/jama.271.24.1925

Cited by 72 publications

(53 citation statements)

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“…12 In perinatally infected infants, the rate of maternal transmission and disease progression appears to correlate with maternal virus burden as well as the timing of infection. [13][14][15] In this study, both groups of HIV-infected children who survived until at least 8 years of age had relatively similar clinical profiles.…”

Section: Discussionmentioning

confidence: 99%

A Descriptive Survey of Pediatric Human Immunodeficiency Virus–infected Long-term Survivors

Nielsen

McSherry

Petru³

et al. 1997

Pediatrics

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ABSTRACT. Objective. To identify the population of human immunodeficiency virus-infected pediatric longterm survivors (LTS) followed in major medical institutions in California, Florida and New Jersey.Methods. A cross-sectional survey was performed with data collection forms sent to all investigators. Demographic, clinical, and laboratory data were obtained on all living patients 8 years infected in the perinatal period with human immunodeficiency virus.Results. A total of 143 perinatally infected and 54 children infected by neonatal transfusion were identified. Fifty-four children (27%) had absolute CD4 counts 500 cells/mm 3 (group 1: mean age 9.8 years), 54 children (27%) had CD4 counts between 200 and 500 cells/mm 3 (group 2: mean age 10.1 years), and 89 children (45%) had CD4 counts <200 cells/mm 3 (group 3: mean age 10.4 years). Ninety-five (48%) patients had developed AIDS defining conditions; 14 (26%) in group 1, 26 (48%) in group 2, and 55 (62%) in group 3. Ninety-two percent of patients had received antiretrovirals. Perinatally human immunodeficiency virus-infected children tended to be younger (mean age 9.8 years) than children infected via a blood transfusion (mean age 11 years). Generalized lymphadenopathy was the most prevalent clinical finding. Lymphoid interstitial pneumonia and recurrent bacterial infections were the most prevalent acquired immune deficiency syndrome-defining conditions. Twenty percent of LTS had CD4 counts 500 cells/mm 3 and no immune deficiency syndrome-defining conditions.Conclusions. Pediatric LTS were in variable stages of disease progression. The proportion of children within each CD4 strata did not differ by mode of acquisition of infection. Increased CD4 counts were inversely proportional to age. Only 20% of pediatric LTS had minimal to no disease progression. Pediatrics 1997;99(4). URL: http: //www.pediatrics.org/cgi/content/full/99/4/e4; HIV, pediatric long-term survivors, slow disease progression.

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Section: Discussionmentioning

confidence: 99%

A Descriptive Survey of Pediatric Human Immunodeficiency Virus–infected Long-term Survivors

Nielsen

McSherry

Petru³

et al. 1997

Pediatrics

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“…The majority of the infected women enrolled in our study were asymptomatic (85% belonged to CDC class A), with a median (25th and 75th percentile) CD4 ϩ T-cell count at delivery of 500 (322 and 687)/mm 3 . Fourteen mothers transmitted HIV-1 to their infants in utero based on positive HIV-1 coculture and PCR within 48 h of delivery.…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…2). ZDV is known to significantly reduce the risk of perinatal transmission, which could confound the interpretation of our results (3,35). We therefore evaluated the data from all mothers who did not receive ZDV in order to determine the relationship between HIV diversity and perinatal transmission in the absence of treatment.…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…The epidemic of HIV-1 infection in women of childbearing age represents a serious threat to children, because more than 95% of infected children acquire HIV-1 from their mothers. Zidovudine (ZDV) treatment of infected mothers during gestation and at delivery and of their infants during the first 6 weeks of life has been shown to decrease the risk of perinatal transmission in treatment-naive, non-breast-feeding women by more than 70% (3,8,36). However, several factors, including advanced maternal disease status, the spread of antiretrovirus-resistant virus, noncompliance with therapy, and lack of an alternative to breast-feeding in certain populations, contribute to the continued spread of HIV-1 infection from mothers to their infants.…”

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confidence: 99%

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Perinatal Transmission of Major, Minor, and Multiple Maternal Human Immunodeficiency Virus Type 1 Variants In Utero and Intrapartum

Dickover

Garratty

Plaeger

et al. 2001

J Virol

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Previous studies have provided conflicting data on the presence of selective pressures in the transmission of a homogeneous maternal viral subpopulation to the infant. Therefore, the purpose of this study was to definitively characterize the human immunodeficiency virus type 1 (HIV-1) quasispecies transmitted in utero and intrapartum. HIV-1 envelope gene diversity from peripheral blood mononuclear cells and plasma was measured during gestation and at delivery in mothers who did and did not transmit HIV perinatally by using a DNA heteroduplex mobility assay. Children were defined as infected in utero or intrapartum based on the timing of the first detection of HIV. Untreated transmitting mothers (n ‫؍‬ 19) had significantly lower HIV-1 quasispecies diversity at delivery than untreated nontransmittting mothers (n ‫؍‬ 18

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“…3 Plasma HIV-1 RNA has been a consistent predictor of "contagion" for percutaneous 4,5 and perinatal transmission. [6][7][8][9][10] This relationship holds true for perinatal transmission in non-B subtype areas. 11 Within the sexual transmission category, anal, oral, and vaginal intercourse bring different levels of risk.…”

Section: Introductionmentioning

confidence: 99%

Virologic and Immunologic Determinants of Heterosexual Transmission of Human Immunodeficiency Virus Type 1 in Africa

Fideli

Allen

Musonda

et al. 2001

AIDS Research and Human Retroviruses

331

281

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More than 80% of the world's HIV-infected adults live in sub-Saharan Africa, where heterosexual transmission is the predominant mode of spread. The virologic and immunologic correlates of femaleto-male (FTM) and male-to-female (MTF) transmission are not well understood. A total of 1022 heterosexual couples with discordant HIV-1 serology results (one partner HIV infected, the other HIV uninfected) were enrolled in a prospective study in Lusaka, Zambia and monitored at 3-month intervals. A nested case-control design was used to compare 109 transmitters and 208 nontransmitting controls with respect to plasma HIV-1 RNA (viral load, VL), virus isolation, and CD4 + cell levels. Median plasma VL was significantly higher in transmitters than nontransmitters (123,507 vs. 51,310 copies/ml, p < 0.001). In stratified multivariate Cox regression analyses, the risk ratio (RR) for FTM transmission was 7.6 (95% CI: 2.3, 25.5) for VL ≥ 100,000 copies/ ml and 4.1 (95% CI: 1.2, 14.1) for VL between 10,000 and 100,000 copies/ml compared with the reference group of <10,000 copies/ ml. Corresponding RRs for MTF transmission were 2.1 and 1.2, respectively, with 95% CI both bounding 1. Only 3 of 41 (7%) female transmitters had VL < 10,000 copies/ml compared with 32 of 93 (34%) of female nontransmitters (p < 0.001). The transmission rate within couples was 7.7/100 person-years and did not differ from FTM (61/862 person-years) and MTF (81/978 person-years) transmission. We conclude that the association between increasing plasma viral load was strong for female to male transmission, but was only weakly predictive of male to female transmission in Zambian heterosexual couples. FTM and MTF transmission rates were similar. These data suggest gender-specific differences in the biology of heterosexual transmission.Address reprint requests to: Grace M. Aldrovandi,

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Factors predictive of maternal-fetal transmission of HIV-1. Preliminary analysis of zidovudine given during pregnancy and/or delivery

Cited by 72 publications

References 0 publications

A Descriptive Survey of Pediatric Human Immunodeficiency Virus–infected Long-term Survivors

A Descriptive Survey of Pediatric Human Immunodeficiency Virus–infected Long-term Survivors

Perinatal Transmission of Major, Minor, and Multiple Maternal Human Immunodeficiency Virus Type 1 Variants In Utero and Intrapartum

Virologic and Immunologic Determinants of Heterosexual Transmission of Human Immunodeficiency Virus Type 1 in Africa

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