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DRAMATIC REDUCTION, BUT NO ELIMINATION, OF PERINATAL HIV TRANSMISSION
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Reported by Jules Levin
Systematic identification of infected pregnant women and application of preventive strategies has dramatically reduced HIV-1 perinatal transmission in developed countries. Nevertheless, some children and their mothers are still diagnosed subsequently. The aim of this study presented orally at the European AIDS Conference (October 2003) is to describe the characteristics, management and outcomes of HIV vertical transmission over a 16-year period. This was a prospective study of children born to HIV-infected women from January 1987 to December 2002 at two teaching hospitals in Barcelona, examining the clinical records from a pediatric unit in a reference center.
447 infants were identified. Protocol ACTG 076 was implemented on October 1994, elective cesarean section in 1997, and HAART in 1998. Vertical transmission rate decreased from 14.9% (34/228) in the years prior to prophylactic ZDV to 3.7% (4/107) in the period 1995-1999 and 0.9% (1/112) thereafter.
The last 5 infected children are currently alive, asymptomatic, receive HAART and remain free from AIDS (2 A1 and 3 N1). From October 1994, 17 additional cases were diagnosed. Their mothers were neither aware of their HIV infection nor identified during pregnancy (13 not tested and 1 HIV negative at the beginning of gestation), rejected prophylaxis (2) or did not control the gestation (1). Three infants died from PCP, 6 have AIDS (5 C1 and 1 B3) and 5 are classified as B1 (1), B2 (1) and B3 (3).
The authors conclude that early identification of HIV infection in pregnant women must be emphasized: prophylactic measures lower the risk of transmission to almost-zero rate, and infants who become infected present with mild clinical conditions and good short to moderate term prognosis.
Reference: 9TH EUROPEAN AIDS CONFERENCE (EACS), 1st EACS RESISTANCE & PHARMACOLOGY WORKSHOP, October 25 - 29, 2003 Warsaw, Poland. Oral Abstract F3/2 - DRAMATIC REDUCTION, BUT NO ELIMINATION, OF PERINATAL HIV TRANSMISSION. Sánchez E. (1), Fortuny C. (2), Loncà M. (3), Coll O. (3), Bogunyà J.M. (2), Muñoz M.C. (2), Jiménez R. (2). (1) Catalan Agency for Health Technology Assessment and Research, Barcelona, (2) Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, (3) Hospital Clínic, Barcelona, Spain
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