UMMS Affiliation

Department of Pediatrics

Date

6-20-2007

Document Type

Article

Subjects

Abortion, Spontaneous; Adult; Antiretroviral Therapy, Highly Active; Cesarean Section; Cohort Studies; Europe; Female; Gestational Age; HIV Infections; HIV-1; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; and numerical data; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Risk Factors; United States; Viral Load

Disciplines

Immunology and Infectious Disease | Life Sciences | Medicine and Health Sciences | Pediatrics

Abstract

BACKGROUND: Rates of mother-to-child transmission of HIV-1 (MTCT) have historically been lower in European than in American cohort studies, possibly due to differences in population characteristics. The Pediatric AIDS Clinical Trials Group Protocol (PACTG) 316 trial evaluated the effectiveness of the addition of intrapartum/neonatal nevirapine in reducing MTCT in women already receiving antiretroviral prophylaxis. Participation of large numbers of pregnant HIV-infected women from the US and Western Europe enrolling in the same clinical trial provided the opportunity to identify and explore differences in their characteristics and in the use of non-study interventions to reduce MTCT.

METHODS: In this secondary analysis, 1350 women were categorized according to enrollment in centres in the USA (n = 978) or in Europe (n = 372). Factors associated with receipt of highly active antiretroviral therapy and with elective caesarean delivery were identified with logistic regression. RESULTS: In Europe, women enrolled were more likely to be white and those of black race were mainly born in Sub-Saharan Africa. Women in the US were younger and more likely to have previous pregnancies and miscarriages and a history of sexually transmitted infections. More than 90% of women did not report symptoms of their HIV infection; however, more women from the US had symptoms (8%), compared to women from Europe (4%). Women in the US were less likely to have HIV RNA levels/ml at delivery than women enrolling in Europe, and more likely to receive highly active antiretroviral therapy, and to start therapy earlier in pregnancy. The elective caesarean delivery rate in Europe was 61%, significantly higher than that in the US (22%). Overall, 1.48% of infants were infected and there was no significant difference in the rate of transmission between Europe and the US despite the different approaches to treatment and delivery.

CONCLUSION: These findings confirm that there are important historical differences between the HIV-infected pregnant populations in Western Europe and the USA, both in terms of the characteristics of the women and their obstetric and therapeutic management. Although highly active antiretroviral therapy predominates in pregnancy in both settings now, population differences are likely to remain.

TRIAL REGISTRATION: NCT00000869.

Rights and Permissions

Citation: BMC Infect Dis. 2007 Jun 20;7:60. Link to article on publisher's site

DOI of Published Version

10.1186/1471-2334-7-60

Comments

© 2007 Newell et al; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Related Resources

Link to Article in PubMed

Journal Title

BMC infectious diseases

PubMed ID

17584491

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