[60] FACTORS ASSOCIATED WITH PERINATAL HIV-1 TRANSMISSION IN MOTHERS AND NON-BREASTFED INFANTS RECEIVING ZIDOVUDINE (ZDV) PROPHYLAXIS

2nd International AIDS Society Conference on HIV Pathogenesis and Treatment

Paris, France - July 13 - 16, 2003

[TITLE:] FACTORS ASSOCIATED WITH PERINATAL HIV-1 TRANSMISSION IN MOTHERS AND NON-BREASTFED INFANTS RECEIVING ZIDOVUDINE (ZDV) PROPHYLAXIS

[AUTHOR(S):] G Jourdain^1,2, JY Mary³, S Le Coeur^2,4, N Ngo-Giang-Huong^1,2, K McIntosh⁵, K Kengsakul⁶, K Boonrod⁷ and M Lallemant^1,2 for the perinatal HIV prevention trial group (PHPT)
¹Harvard School of Public Health, Boston, USA; ²UR54-IRD054 Institut de Recherche pour le Développement, Chiang Mai, Thailand; ³Paris 7 University/INSERM U444, Paris, France; ⁴ Institut National d'Etudes Demographiques, Paris, France; ⁵ Harvard School of Medicine, Boston, United States; ⁶ Bhumibol Adulyadej Hospital, Bangkok, Thailand; and ⁷ Banglamung Hospital, Thailand

IAS Conf HIV Pathog Treat 2003 Jul 13-16;2nd: Abstract No. 60
Antiviral Therapy 2003; 8(Suppl. 1):S198

[ABSTRACT:] Purpose: HIV perinatal transmission-associated factors in mothers and non breastfed infants receiving ZDV have been studied in clinical trials with relatively low sample size.

Methods: PHPT-1 was a multicentre, randomized, controlled trial in Thailand, with a factorial design: maternal ZDV starting at 28 or 35 weeks' gestation, 6 weeks or 3 days ZDV in formula-fed infants (N Engl J Med 2000; 343). Out of 1 409 infants born to 1437 women, HIV status by Roche Amplicor 1.5 DNA PCR was available for 1386 infants (98.4%). There were 97 HIV transmissions: 42% 'early', i.e. PCR+ within 1 week of birth, and 58% 'late', i.e. PCR+ after PCR- in the first week. Analyses were adjusted on maternal/child treatment assignment (including interaction). P value for factor selection was <0.05.

Results: Overall transmission was associated with baseline viral load (VL) >10,000 cp/ml, baseline maternal creatinine >1 mg/dL, pregnancy complications, labour >24 h, prematurity (Ballard score) and birth weight <2 500 g (LBW). Early transmission was associated with VL>10,000, creatinine>1 mg/dL, pregnancy complications, labor>24 h, prematurity and LBW. Late transmission was associated with VL>10,000 and CD4<200 (versus >350). Upon multiple logistic regression, VL>10 000 (OR: 3.2; 95%CI=1.9–5.3), creatinine>1 mg/dL (OR=2.5; 1.2–5.2), low birth weight (OR: 2.1; 1.2–3.7) and labor >24 h (OR: 3.6; 1.1–11.4) remained independently associated with overall transmission; labor >24 h (OR: 5.6; 1.5–21.0), low birth weight (OR: 2.8; 1.3–6.3) and creatinine >1 mg/dL (OR=2.9; 1.1–8.0) with early infection, and only VL>10,000 with late transmission (OR=4.7; 2.3–9.4).

Conclusions: Factors independently associated with early and late transmission despite ZDV may give insight on the mechanisms of transmission or of ZDV prophylaxis failure. The pathogenesis significance of elevated creatinine in relation to transmission needs to be investigated. Support: NIH R01 HD33326, IRD, Roche Diagnostics, GlaxoWellcome.

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