This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (133)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • HIV/AIDS  • Alert me on articles by topic

Interaction Between Zidovudine Prophylaxis and Mode of Delivery in the French Perinatal Cohort

Laurent Mandelbrot, MD; Jérôme Le Chenadec, MS; Alain Berrebi, MD; André Bongain, MD; Jean-Louis Bénifla, MD; Jean-François Delfraissy, MD; Stéphane Blanche, MD; Marie-Jeanne Mayaux, BA; for the French Perinatal Cohort

JAMA. 1998;280:55-60.

Context.— It is unclear whether elective cesarean delivery may have a protective effect against the transmission of human immunodeficiency virus 1 (HIV-1).

Objective.— To investigate whether mode of delivery has an impact on perinatal HIV-1 transmission in the presence of zidovudine prophylaxis.

Design.— A prospective cohort study.

Setting.— The 85 perinatal centers in the French Perinatal Cohort, from 1985 to 1996.

Patients.— A total of 2834 singleton children born to mothers with HIV-1 infection.

Main Outcome Measure.— Human immunodeficiency virus 1 infection of the infant.

Results.— No zidovudine was used in 1917 pregnancies and zidovudine prophylaxis was used in 902 pregnancies. Cesarean deliveries were performed in 10.9% on an emergent basis and in 8.3% electively, prior to labor or membrane rupture. In 1917 mothers who did not receive zidovudine, of 1877 with information on mode of delivery, 17.2% transmitted HIV-1 to their child. Risk factors statistically significantly associated with transmission were maternal p24 antigenemia, cervicovaginal infections during pregnancy, amniotic fluid color, and rupture of membranes 4 hours or more before delivery. Mode of delivery was not related to transmission. In 902 mothers receiving zidovudine, transmission was 6.4% in 872 with information on mode of delivery, and elective cesarean delivery (n=133) was associated with a lower transmission rate than emergent cesarean or vaginal delivery (0.8%, 11.4%, and 6.6%, respectively; P=.002). In a multivariate analysis of all mother-child pairs, including obstetrical risk factors, maternal p24 antigenemia, and zidovudine prophylaxis, interaction between mode of delivery and zidovudine prophylaxis was significant (P=.007). In the multivariate analysis of pregnancies with zidovudine prophylaxis, factors related to transmission rate were maternal p24 antigenemia, amniotic fluid color, and mode of delivery. Adjusted odds ratios (95% confidence intervals) were 1.6 (0.7-3.6) for emergent cesarean delivery and 0.2 (0.0-0.9) for elective cesarean delivery (P=.04) in comparison with vaginal delivery.

Conclusions.— We observed an interaction between zidovudine prophylaxis and elective cesarean delivery in decreasing transmission of HIV-1 from mother to child. This observation may have clinical implications for prevention.

From the Service de Gynécologie-Obstétrique I, Hôpital Cochin-Port Royal and the Institut National de la Santé et de la Recherche Médicale (INSERM) U149, Paris, France (Dr Mandelbrot); INSERM U292, Kremlin-Bicêtre, France (Mr Le Chenadec and Ms Mayaux); Service de Gynécologie-Obstétrique, Hôpital de La Grave, Toulouse, France (Dr Berrebi); Service de Gynécologie-Obstétrique, Hôpital de L'Archet 2, Nice, France (Dr Bongain); Service de Gynécologie-Obstétrique, Hôpital Bichat, Paris (Dr Bénifla); Service de Médecine Interne, Hôpital de Kremlin-Bicêtre (Dr Delfraissy); and the Service de Pédiatrie, Hôpital Necker, Paris (Dr Blanche).

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Encouraging results despite complexity of multidisciplinary care of HIV-infected women using assisted reproduction techniques
Ohl et al.
Hum Reprod 2005;20:3136-3140.
ABSTRACT | FULL TEXT  

Decline in mortality in children with HIV in the UK and Ireland: Argument is flawed
Mhlongo and Maduna
BMJ 2004;328:523-523.
FULL TEXT  

Human Immunodeficiency Virus: Anesthetic and Obstetric Considerations
Evron et al.
Anesth. Analg. 2004;98:503-511.
ABSTRACT | FULL TEXT  

Canadian consensus guidelines for the management of pregnancy, labour and delivery and for postpartum care in HIV-positive pregnant women and their offspring (summary of 2002 guidelines)
Burdge et al.
CMAJ 2003;168:1671-1674.
FULL TEXT  

Assisted reproduction techniques for HIV serodiscordant couples: 18 months of experience
Ohl et al.
Hum Reprod 2003;18:1244-1249.
ABSTRACT | FULL TEXT  

Human Immunodeficiency Virus Infection in Pregnancy
Minkoff
Obstet Gynecol 2003;101:797-810.
ABSTRACT | FULL TEXT  

Determinants of Mother-to-Infant Human Immunodeficiency Virus 1 Transmission Before and After the Introduction of Zidovudine Prophylaxis
The Italian Register for Human Immunodeficiency Vi
Arch Pediatr Adolesc Med 2002;156:915-921.
ABSTRACT | FULL TEXT  

HIV disease and respiratory infection in children
Graham and Gibb
Br Med Bull 2002;61:133-150.
ABSTRACT | FULL TEXT  

Contribution of Immune Activation to the Pathogenesis and Transmission of Human Immunodeficiency Virus Type 1 Infection
Lawn et al.
Clin. Microbiol. Rev. 2001;14:753-777.
ABSTRACT | FULL TEXT  

Lamivudine-Zidovudine Combination for Prevention of Maternal-Infant Transmission of HIV-1
Mandelbrot et al.
JAMA 2001;285:2083-2093.
ABSTRACT | FULL TEXT  

Combination Prophylaxis for Prevention of Maternal-Infant HIV Transmission: Beyond 076
Shaffer
JAMA 2001;285:2129-2131.
FULL TEXT  

HIV transmission Prevention of Perinatal HIV-1 Transmission in the United States
Shetty and Maldonado
NeoReviews 2001;2:e83-93.
FULL TEXT  

Understanding the Timing of HIV Transmission From Mother to Infant
Kourtis et al.
JAMA 2001;285:709-712.
FULL TEXT  

Cost-Effectiveness of Elective Cesarean Delivery in Human Immunodeficiency Virus-Infected Women
CHEN et al.
Obstet Gynecol 2001;97:161-168.
ABSTRACT | FULL TEXT  

Prevention of perinatal HIV transmission during pregnancy
McGowan and Shah
J Antimicrob Chemother 2000;46:657-668.
ABSTRACT | FULL TEXT  

False-Positive and Indeterminate Human Immunodeficiency Virus Test Results in Pregnant Women
Doran and Parra
Arch Fam Med 2000;9:924-929.
ABSTRACT | FULL TEXT  

Risk Factors for Perinatal Human Immunodeficiency Virus Transmission in Patients Receiving Zidovudine Prophylaxis
SHAPIRO et al.
Obstet Gynecol 1999;94:897-908.
ABSTRACT | FULL TEXT  

Vertical transmission rates for HIV in the British Isles: estimates based on surveillance data
Duong et al.
BMJ 1999;319:1227-1229.
ABSTRACT | FULL TEXT  

PRIMARY HUMAN IMMUNODEFICIENCY VIRUS TYPE 1 INFECTION IN PREGNANCY
Keerasuntonpong et al.
Obstet Gynecol 1999;94:844-844.
FULL TEXT  

Labour care of women with HIV infection
Taylor et al.
BMJ 1999;319:381a-381.
FULL TEXT  

Risk Factors for Perinatal Transmission of Human Immunodeficiency Virus Type 1 in Women Treated with Zidovudine
Mofenson et al.
NEJM 1999;341:385-393.
ABSTRACT | FULL TEXT  

Maternal Levels of Plasma Human Immunodeficiency Virus Type 1 RNA and the Risk of Perinatal Transmission
Garcia et al.
NEJM 1999;341:394-402.
ABSTRACT | FULL TEXT  

Universal HIV screening of pregnant women in England: cost effectiveness analysis
Postma et al.
BMJ 1999;318:1656-1660.
ABSTRACT | FULL TEXT  

Prophylactic Cesarean Delivery for the Prevention of Perinatal Human Immunodeficiency Virus Transmission: The Case for Restraint
Stringer et al.
JAMA 1999;281:1946-1949.
FULL TEXT  

The Mode of Delivery and the Risk of Vertical Transmission of Human Immunodeficiency Virus Type 1 -- A Meta-Analysis of 15 Prospective Cohort Studies
The International Perinatal HIV Group
NEJM 1999;340:977-987.
ABSTRACT | FULL TEXT  

Short Courses of Zidovudine and Perinatal Transmission of HIV
Fiscus et al.
NEJM 1999;340:1040-1043.
FULL TEXT  

HIV Screening and Treatment of Pregnant Women and Their Newborns: A Simulation-Based Analysis
Anderson and Anderson
SIMULATION 1998;71:276-284.
ABSTRACT  

Elective Cesarean Sections Reduce Perinatal HIV Transmission
AIDS Clin Care 1998;1998:6-6.
FULL TEXT  

Cesarean Delivery for Prevention of HIV Transmission
JWatch Infect. Diseases 1998;1998:4-4.
FULL TEXT  

C-Section and HIV Transmission with Zidovudine
JWatch Women's Health 1998;1998:1-1.
FULL TEXT