2nd National Conference Human Retroviruses and Related Infections Washington, DC - January 29 - February 2, 1995

Natl Conf Hum Retrovir Relat Infect 1995 Jan 29-Feb 2;2: (abstract no. 11)

Matheson P, Thomas P, Abrams EJ, Hernan MA, Thea DM, Lambert G, Krasinski K, Bamji M, Rogers MF, Heagarty M, and the New York City Perinatal HIV Transmission Collaborative Study
MHRA, 40 Worth St., New York, NY 10013

321 HIV-infected women were enrolled during pregnancy or within 6 weeks of delivery and their infants were studied prospectively as part of a multicenter collaborative study in New York City. From April 1986 through December 1993, data were collected on maternal lymphocyte subsets, ZDV use during pregnancy, and infant HIV-1 infection status. ZDV use during pregnancy and level of immunosuppression (CD4+ cells/µliter closest to delivery) were entered in a logistic regression model to estimate their adjusted effects upon HIV-1 perinatal transmission. Mothers who received ZDV were less likely {13% (6/47)} than mothers who did not {23%, (64/274} to transmit HIV-1 to their infants (adjusted OR=.34, 95% CI=0.13-0.88,p=0.026). While ZDV use was highly correlated with degree of immunosuppression, there was no conclusive evidence that the efficacy of ZDV depended upon CD4 level, since the interaction term between CD4 and ZDV use was nonsignificant. Maternal ZDV use relative to non-use was associated with a decrease in transmission of 55% when CD4 less than 200 (OR=0.42, 95% CI=0.09-1.9), 56% when CD4 200-499 (OR=0.46, 95% CI=0.12-1.7), and 100% when CD4 >500 (OR=0.00, 95% CI=0.01-2,7). Though more of the 321 newborns received oral ZDV, significantly more infants of ZDV-using mothers had elevated mean corpuscular volume (>112 fL) than newborns of mothers who did not (35% vs 5%, p<0.001), suggesting maternal ZDV use up to the time of delivery. The reduction in mother-to-child transmission of HIV-1 associated with antenatal ZDV use alone raises the possibility that the success of the ACTG 076 ZDV regimen may result primarily from maternal oral treatment. Further investigation of the efficacy of the other two treatment components (maternal intravenous intrapartum ZDV and newborn oral ZDV) is warranted. Pregnant women with high levels of immunosuppression who are at higher risk of transmission may also benefit from antepartum ZDV treatment.

Keywords: Acquired Immunodeficiency Syndrome, Antigens, CD4, Child, Delivery, Obstetric, Disease Transmission, Vertical, Female, HIV Infections, HIV Seropositivity, HIV-1, HIV-1 Reverse Transcriptase, Humans, Infant, Infant, Newborn, New York City, Pregnancy, Zidovudine, immunology, surgery, therapy, transmission

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1995-01-29
11

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