n South African Journal of Obstetrics and Gynaecology - Risk factors for perinatal HIV-1 transmission in pregnant women requiring lifelong antiretroviral therapy : a longitudinal study at a tertiary hospital in South Africa : research




. To estimate the infant HIV-1 transmission rate and to evaluate risk factors for transmission in pregnant women at an Eastern Cape tertiary hospital requiring lifelong antiretroviral therapy (ART).

. Pregnant women who initiated lifelong ART during pregnancy and others who conceived on lifelong ART were followed up antenatally, through delivery, until 6 weeks postpartum. A qualitative HIV-1 DNA polymerase chain reaction (PCR) was done on the infants at 6 weeks. Risk factors evaluated for perinatal HIV transmission included CD4 count, duration of ART, plasma HIV-1 RNA viral load (VL) at delivery, preterm birth, and mode of delivery.
. Data on 838 women with 858 live births are presented. The median CD4 count was 192 cells/μl, and the median duration of ART was 12 weeks. Of 618 women (73.7%) with VL results at delivery, 555 women (89.8%) had a VL <1 000 copies/ml. HIV-1 DNA PCR was performed on 665 out of 831 infants (80%) from 6 weeks onwards. Transmission occurred in 16 infants (2.4%; 95% confidence interval (CI) 1.4 - 4.0). The transmission rate was 7.8% with maternal plasma VL ≥1 000 copies/ml (=0.018), 4.2% with duration of ART <10 weeks (=0.010), and 8.6% with preterm birth (=0.046). On multivariable regression analysis VL ≥1 000 copies/ml (adjusted odds ratio (AOR) 12.82; 95% CI 1.72 - 95.53) and duration of ART <10 weeks (AOR 4.91; 95% CI 1.40 - 17.18) remained significant predictors of transmission.
. Maternal plasma VL at delivery and duration of ART are significant independent predictors of perinatal HIV-1 transmission, but transmission can occur with undetectable plasma VL at delivery.


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