3rd Conference on Retroviruses and Opportunistic Infections Washington, DC - January 28-February 1, 1996

Conf Retroviruses Opportunistic Infect 1996 Jan 28-Feb 1; 3rd:58 (abstract no. 30)

Shaffer N^1,2, Chotpitayasunondh T³, Roongpisuthipong A⁴, Siriwasin W⁵, Chearskul S⁴, Young N^1,2,, Brown T², Nieburg P², Batter V², Kalish ML², Mastro TD^1,2,
1 HIV/AIDS Collaboration, Nonthaburi; ² CDC, Atlanta; ³ Children's Hospital, Bangkok; ⁴ Rajvithi Hospital Bangkok

OBJECTIVES: To assess the role of maternal plasma viral load as a determinant of perinatal HIV-1 transmission and predictor of early infant outcome.

METHODS: A multicenter cohort of HIV-infected women enrolled during pregnancy and their bottle-fed infants was followed prospectively to determine infant infection status (by PCR), and risk factors for perinatal transmission. Quantitative HIV RNA testing (NASBA, Organon Teknika) was performed in a consecutive sample of 146 maternal delivery specimens.

RESULTS: From NOV 92- MAR 94, 342 HIV-infected women were enrolled. Enrolled mothers were: young (median age 22 yrs), primipara (57%), asymptomatic (94%), and seroreactive to HIV subtype E (93%). Most (65%) had CD4 counts less than 500/muL. Of 295 (86%) mothers who remained in the study at delivery, infection status could be determined for 281 (95%) infants. The transmission rate was 24.2% (95 % CI 19-29%). Transmission was associated with: low maternal CD4 count (p 0.03); vaginal delivery (p = 0.07); prematurity (p = 0.02) and high ( greater than 8,000 copies/ml) viral load (P = 0.004). On multivariate analysis, prematurity (p = 0.03) and high viral load remained significantly associated with transmission. Infant mortality among 21 HIV-infected infants whose mothers had high viral load was 26%, compared to O % among 16 infected infants whose mothers had low viral load (p = 0.02).

CONCLUSIONS: The perinatal transmission rate for HIV-1 subtype E in Bangkok is 24%, comparable to rates for other subtypes reported elsewhere. Higher maternal viral load at delivery is associated with increased transmission risk, but the risk appears to be multifactorial. Infected infants born to mothers with high viral load at delivery are at high risk for early, rapid progression of disease.

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Copyright © 1996 - Foundation for Retrovirology and Human Health . Reproduction of this abstract (other than one copy for personal reference) must be cleared through the Foundation for Retrovirology and Human Health.