Low Rates of Mother-to-child Transmission of HIV-1 and Risk Factors for Infection in Spain

Abstract

Low MTCT rates were observed over time. Lack of timely provision of antiretroviral drugs was the main limitation to develop all preventive interventions available nowadays. Nonsustained control of viral load could be associated with residual transmission.

Earlier initiation of ART and further decline in mother-to-child HIV transmission rates, 2000–2011

“…MTCT rates of 0.5-1% have been reported from observational cohort studies in other resource-rich settings in Europe and North America[6,[31][32][33][34][35]. However, to our knowledge, such low rates have not been previously achieved in such a large unselected population.…”

“…However, perinatal HIV transmission is almost entirely preventable through a multipronged approach involving universal antenatal HIV screening, careful management of pregnancy including appropriate antiretroviral therapy (ART) and mode of delivery, neonatal antiretroviral prophylaxis, and avoidance of breastfeeding. These interventions have resulted in dramatic reductions in MTCT, and many countries in northern and western Europe have already achieved rates of less than 2% [3][4][5][6], in line with the WHO goal for virtual elimination of MTCT in the European region by 2015 [7]. Rates in eastern European countries remain higher, although there has also been significant progress [8,9].…”

“…In those starting cART in pregnancy and with information available (18/21), median duration of cART was 12.9 weeks (IQR 4. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Median maternal viral load was 712 copies/ml (IQR 194-19 214 copies/ml, n ¼ 20) at a median 13.5 days before delivery (IQR 0.5-23.5).…”

Elimination of perinatal HIV infection in the USA and other high-income countries

“…In SMARTT during 2007-2011, effective combination antiretroviral therapy (cART) use was reported by 85% of women in the ‘dynamic’ cohort [23]. Similar high rates of cART use have been seen in several European countries [7, 28, 41], where its use is frequently reported at the time of conception [16, 41]. Though ARV resistance has been recognized in maternal and infant viral strains, it is not clear that the proportion of affected individuals has changed, nor is the effect on MCT clear [42].…”

“…Among mothers of HIV-infected infants reported to US National HIV Surveillance during 2003-2007, 21% were born in countries other than the US [26]. The annual percentage of HIV-infected pregnant women born in Africa and delivering was 24-78% in several western European countries during the past decade [7, 12, 27, 28]. Immigrant women were at some risk of less frequent uptake of PMTCT interventions, specifically, accessing prenatal care and ARV initiation [27, 29].…”