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Determinants of Mother-to-Infant Human Immunodeficiency Virus 1 Transmission Before and After the Introduction of Zidovudine Prophylaxis
The Italian Register for Human Immunodeficiency Virus Infection in Children
Arch Pediatr Adolesc Med. 2002;156:915-921.
Background Randomized controlled trials have demonstrated that zidovudine therapy
decreases the mother-to-infant transmission of human immunodeficiency virus
1 (HIV-1). Data from large observational studies may provide further important
findings on the effectiveness at the population level of combined treatments
in decreasing transmission.
Objective To evaluate time trends in prophylactic interventions and the determinants
of transmission both before and after the introduction of antiretroviral prophylaxis,
and in treated and untreated mother-infant pairs after 1995.
Design and Setting Analysis of prospective data on 3770 children born to HIV-1–infected
women between 1985 and 1999 and reported to the Italian Register for HIV Infection
in Children.
Main Outcome Measures Logistic regression random effects models were used to estimate crude
and adjusted odds ratios for several factors potentially influencing vertical
transmission for 2 periods—1985 through 1995 (January 1, 1985, through
December 31, 1995) and 1996 through 1999 (January 1, 1996, through December
31, 1999), and between treated and untreated children after 1995.
Results The transmission rate was 15.5% in the 1985-1995 period and 5.8% in
the 1996-1999 period. By 1999, prophylactic interventions had greatly increased.
Antiretroviral treatment (ART) usage was 89.9%, (55.1% combination ART) and
the elective cesarean delivery rate was 81.3%. In multivariate analysis, only
elective cesarean delivery was associated with a lower risk of mother-to-infant
transmission before 1995. After 1995, nonbreastfeeding and receipt of ART
were protective whereas elective cesarean delivery was not significantly protective
in multivariate analysis. Transmission risk was reduced by 76% with an incomplete
zidovudine regimen, 88% with a complete regimen, and 93% when the mother received
combination ART. In the 1996-1999 period, the transmission rate for nonbreastfeeding
mother-infant pairs was 8.6% with elective cesarean delivery, 4.4% with any
ART, and 2.4% with these interventions combined.
Conclusion Prophylactic interventions, and in particular ART, reduced perinatal
HIV-1 transmission at a population level in Italy.
This study was supported by the Italian Ministero della Sanità, Istituto Superiore di Sanità, Progetto AIDS 2000, Rome.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Prenatal Screening for HIV: A Review of the Evidence for the U.S. Preventive Services Task Force
Chou et al.
ANN INTERN MED 2005;143:38-54.
ABSTRACT
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Successes and Challenges in the Perinatal HIV-1 Epidemic in the United States as Illustrated by the HIV-1 Serosurvey of Childbearing Women
Mofenson
Arch Pediatr Adolesc Med 2004;158:422-425.
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