16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

ILLNESS DURING PREGNANCY IS ASSOCIATED WITH IN UTERO HUMAN IMMUNODEFICIENCY VIRUS TYPE-1 (HIV-1) TRANSMISSION

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. ThAc0102

Farquhar C.¹, Mbori-Ngacha D.², Harris J.³, Wamalwa D.², Bosire R.⁴, Redman M.⁵, Gichuhi C.², Obimbo E.², Overbaugh J.⁵, John-Stewart G.^1
1 University of Washington, Medicine and Epidemiology, Seattle, United States, ² University of Nairobi, Paediatrics, Nairobi, Kenya, ³ Department of Public Health, Seattle, United States, ⁴ Kenya Medical Research Institute, Nairobi, Kenya, ⁵ Fred Hutchinson Cancer Research Center, Seattle, United States

BACKGROUND: As interventions to reduce intrapartum HIV-1 transmission risk become more accessible in sub-Saharan Africa, in utero transmission will account for a greater proportion of pediatric HIV-1 infections.

METHODS: We examined correlates of infant HIV-1 acquisition in utero in a cohort of 488 babies born to HIV-1-seropositive mothers in Nairobi. Women were enrolled antenatally and provided zidovudine beginning at 34 weeks gestation and intrapartum.

RESULTS: Twenty-nine (6%) babies had detectable HIV-1 DNA or RNA within 48 hours of birth and were defined as infected in utero. Using logistic regression, women transmitting HIV-1 in utero were compared to non-transmitting women and those transmitting HIV-1 at later timepoints. In univariate analyses, higher maternal HIV-1 viral load, lower CD4 percent, fewer weeks of zidovudine, and lower infant gestational age were significantly associated with greater transmission risk (p<0.001, p=0.008, p=0.04, and p=0.01, respectively) and there was a trend for female babies to be more likely to be infected (p=0.06). Risk of in utero HIV-1 acquisition was also increased among women reporting an HIV-associated illness during the last year (p=0.01) and among women with illness during pregnancy, which included fever, cough and diarrhea (p=0.01). In multivariate analysis, higher maternal plasma HIV-1 RNA and lower infant birthweight were significant risk factors for in utero transmission (Odds ratio [OR], 2.0; 95% confidence interval [CI], 1.2 – 3.3, p=0.01 and OR, 2.0; 95% CI, 1.0 – 3.9, p=0.04, respectively). In addition, women with history of fever, cough or diarrhea during pregnancy were ≈ 3-fold more likely to transmit (OR, 2.9 95% CI, 1.3 – 6.3; p=0.008).

CONCLUSIONS: Illness during pregnancy was an independent risk factor for in utero HIV-1 transmission in this cohort. Prevention and treatment of co-infections should be considered as potential interventions to reduce HIV-1 transmission during the antenatal period.

Download PDF of this abstract.

Download Power Point Presentation.

2006-08-13
ThAc0102

Copyright © 2006 - International AIDS Society (IAS). All information and content relating to the abstracts from the 16th International AIDS Conference, such as text, graphics, logos, button icons, images, audio clips, and software is protected by copyright. Permission is hereby granted for the non-commercial use or reproduction of the information on this web site, provided that the use of such information is accompanied by an acknowledgement that IAS is the source of the information and the name of the author of the article.

AEGiS is a 501c(3) not-for-profit organization made possible through unrestricted funding from Boehringer Ingelheim, Bridgestone/Firestone Charitable Trust, Bristol-Myers Squibb Company, Elton John AIDS Foundation, GlaxoSmithKline, the National Library of Medicine, Roche / Trimeris, and donations from users like you. Always watch for outdated information. This article first appeared in 2006. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2006. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. Permission is hereby granted for the non-commercial use or reproduction of the information herein, provided that the use of such information is accompanied by an acknowledgement that IAS is the source of the information and the name of the author of the article.