Risk for Perinatal HIV-1 Transmission According to Maternal Immunologic, Virologic, and Placental Factors
- Michael E. St. Louis, MD;
- Munkolenkole Kamenga, MD;
- Christopher Brown, MD;
- Ann Marie Nelson, MD;
- Tarande Manzila, MD;
- Veronique Batter, MS;
- Frieda Behets, MPH;
- Uwa Kabagabo, MD;
- Robert W. Ryder, MD;
- Margaret Oxtoby, MD;
- Thomas C. Quinn, MD;
- William L. Heyward, MD
- From Projet SIDA, Kinshasa, Zaire (Drs St. Louis, Kamenga, Brown, Nelson, Manzila, Kabagabo, Ryder, and Heyward and Mss Batter and Behets); Division of HIV/AIDS, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga (Drs St. Louis, Oxtoby, and Heyward and Ms Batter); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md (Drs Brown and Quinn); and Armed Forces Institute of Pathology, Washington, DC (Dr Nelson).
Abstract
Objective. —To evaluate how maternal and obstetric factors interact to influence mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission.
Design. —Prospective, observational cohort study of children born to HIV-infected women to determine child's HIV infection status. The analysis then compared peripartum maternal, placental, and obstetric variables between HIV-1 transmitter and nontransmitter women.
Setting. —Two large maternity wards in Kinshasa, Zaire.
Participants. —Consecutive sample of 324 HIV-1—infected women at delivery, with 254 HIV-seronegative women followed up as control subjects.
Principal Outcome Measures. —HIV infection status of children, to classify each woman as an HIV-1 transmitter or nontransmitter.
Results. —The highest transmission risk (TR) was associated with maternal p24 antigenemia (TR, 71%; relative risk [RR], 3.0; 95% confidence interval [CI], 1.7 to 5.2) and maternal CD8+ lymphocyte counts of at least 1.80×109/L (1800/μL) (TR, 50%; RR, 2.2; 95% CI, 1.2 to 4.2). Among women with CD8+ lymphocyte counts of less than 1.80×109/L, CD4+ lymphocyte counts of less than 0.60×109/L were a risk factor (TR, 29%; RR, 2.2; 95% CI, 1.2 to 4.2). In women with neither high CD8+ nor low CD4+ lymphocyte counts, placental membrane inflammation was associated with perinatal transmission (TR, 40%; RR, 4.2; 95% CI, 1.3 to 13.7). In women with neither p24 antigenemia, high CD8+ or low CD4+ lymphocyte counts, nor placental membrane inflammation, the transmission risk was only 7%. Additional correlates of transmission included maternal anemia and fever, but not maternal sexually transmitted diseases.
Conclusions. —Identifiable subgroups of HIV-1—infected women based on maternal and placental characteristics had between a 7% and 71% risk of perinatal HIV-1 transmission. Not only the overall rate of transmission but the impact of different risk factors for transmission appear to vary over the course of HIV infection.
(JAMA. 1993;269:2853-2859)
Footnotes
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The opinions and assertions herein are those of the authors and do not necessarily reflect the view of the Departments of Health and Human Services or Defense.
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Use of trade names is for identification only and does not imply endorsement by the Public Health Service or by the US Department of Health and Human Services.
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Reprint requests to Centers for Disease Control and Prevention, 1600Clifton Rd, Mailstop E-50, Atlanta, GA 30333 (Dr St. Louis).
