Vertical transmission of HIV in Belgium: a 1986–2002 retrospective analysis

Abstract

Prophylactic interventions have lead to the reduction of the mother-to-child transmission (MTCT) of human immunodeficiency virus type 1 (HIV-1) to less than 2% in industrialized countries. The aim of this study was to evaluate the changes over time in vertical transmission according to the standard care of prophylaxis in the practice of a single large reference center and to identify the risk factors for failure. The rate of MTCT decreased progressively from 10% in 1986-1993 to 4.7% in 1999-2002, reflecting the progressive implementation of newly available means of prevention. During the last period evaluated (1999)(2000)(2001)(2002), where highly active antiretroviral therapy (HAART) prophylaxis was the standard of care, 17% of women had a viral load between 400 and 20,000 copies/ml around delivery and 5% had a viral load above 20,000 copies/ml. High viral load and low CD4 lymphocyte count were strongly associated with vertical transmission. The rate of MTCT in women who received HAART for more than one month during pregnancy was 1.7%, compared to 13.3% in women treated with HAART for less than one month. The risk of vertical transmission in the absence of therapy was four times higher than before the era of antiretroviral therapy (ART; p=0.05). In conclusion, since the prevention of MTCT of HIV with HAART is the standard of care, a short duration or absence of ART during pregnancy linked to late or absent prenatal care is associated with a high risk of transmission. The early detection of HIV-1 infection in pregnant women, and close follow up and support during pregnancy are crucial to the success of the prevention of transmission.

Mother-to-child transmission of HIV infection in Manaus, State of Amazonas, Brazil

“…These rates found in Brazil are higher than those reported in studies published in Europe, where prophylactic measures are implemented early in pregnancy, resulting in mother-to-child transmission rates of around 1% [21][22][23][24][25] .…”

High Incidence of Invasive Group B Streptococcal Infections in HIV-Exposed Uninfected Infants

“…Preventive measures to reduce the risk for MTCT have been implemented over time according to published guidelines as previously described. 25 …”

Impact of antiretroviral therapy on fertility desires among HIV-infected persons in rural Uganda

“…However, the advent of available highly active antiretroviral therapy (HAART) in many sub-Saharan African countries has changed the situation for HIV-positive persons. HAART has been shown to drastically reduce the risk of MTCT of HIV: The risk of MTCT in Denmark was less than 1% in all HIV-positive women (all on HAART) who gave birth between 2000-2005, and 1.7% in a large reference center for pregnant HIV-positive women in Belgium [6,7]. Similarly, HAART has been found to reduce the risk of vertical transmission of HIV in sub-Saharan African countries.…”