Identification of levels of maternal HIV-1 RNA associated with risk of perinatal transmission. Effect of maternal zidovudine treatment on viral load [see comments] NLM AIDSLINE Important note: Information in this article was accurate in 1996. The state of the art may have changed since the publication date.

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Identification of levels of maternal HIV-1 RNA associated with risk of perinatal transmission. Effect of maternal zidovudine treatment on viral load [see comments]

JAMA. 1996 Feb 28;275(8):599-605. Unique Identifier : AIDSLINE MED/96174498
Dickover RE; Garratty EM; Herman SA; Sim MS; Plaeger S; Boyer PJ; Keller M; Deveikis A; Stiehm ER; Bryson YJ; Department of Pediatrics, UCLA School of Medicine 90024, USA.

Abstract: OBJECTIVE: To determine if there are levels of human immunodeficiency virus type 1 (HIV-1) associated with a high or low risk of perinatal transmission and to ascertain the mechanism by which zidovudine treatment reduces perinatal transmission. DESIGN: A nonrandomized prospective cohort study. SETTING: University medical center and two general hospital affiliates from May 1989 to September 1994. PATIENTS: Ninety-two HIV-1-seropositive women (95 pregnancies) and their 97 infants. INTERVENTION: Forty-two mothers (43 pregnancies) received zidovudine therapy during pregnancy and/or during labor and delivery. Eleven infants received prophylactic zidovudine for the first 6 weeks after delivery. MAIN OUTCOME MEASURE: HIV-1 infection status of the infant. RESULTS: Twenty of the 97 infants were perinatally infected with HIV-1. Transmitting mothers were more likely to have plasma HIV-1 RNA levels higher than 50000 copies per milliliter at delivery than nontransmitting mothers (15 [75.0%] of 20 transmitters vs four [5.3%] of 75 nontransmitters; P < .001). None of the 63 women with less than 20000 HIV-1 RNA copies per milliliter transmitted. Twenty-two women treated with open-label oral zidovudine during gestation showed an eightfold median decrease in plasma RNA levels (median [25th and 75th percentile], 43043 [5699 and 63053] copies per milliliter before zidovudine vs 4238 [603 and 5116] HIV-1 RNA copies per milliliter at delivery; P < .001) and none transmitted. Four zidovudine-treated women with high HIV-1 levels transmitted despite the presence of zidovudine-sensitive virus in vitro in both the mothers and their infants. CONCLUSIONS: Maternal HIV-1 RNA levels were highly predictive of perinatal transmission risk and suggest that certain levels of virus late in gestation and/or during labor and delivery are associated with both a high risk and a low risk of transmission. Our results also suggest that zidovudine exerts a major protective effect by reducing maternal HIV-1 RNA levels prior to delivery and that further strategies are needed to prevent perinatal transmission in women with high or increasing virus levels and/or zidovudine-resistant virus.
Keywords: Antiviral Agents/ADMINISTRATION & DOSAGE/*THERAPEUTIC USE AIDS Serodiagnosis/METHODS Cohort Studies Delivery *Disease Transmission, Vertical/PREVENTION & CONTROL Drug Resistance, Microbial DNA, Viral/BLOOD Female Gestational Age Human HIV Infections/BLOOD/CONGENITAL/DRUG THERAPY/*TRANSMISSION HIV Seropositivity/BLOOD/CONGENITAL/DRUG THERAPY/TRANSMISSION *HIV-1/DRUG EFFECTS/ISOLATION & PURIF Infant Infant, Newborn Polymerase Chain Reaction Pregnancy Pregnancy Complications, Infectious/BLOOD/DRUG THERAPY/*VIROLOGY Prospective Studies Risk RNA, Viral/*BLOOD Support, U.S. Gov't, P.H.S. Zidovudine/ADMINISTRATION & DOSAGE/*THERAPEUTIC USE JOURNAL ARTICLE MULTICENTER STUDY

KWDantiviralagents/administration&dosage/KWDtherapeuticuseaidsserodiagnosis/methodscohortstudiesdeliveryKWDdiseasetransmission,vertical/prevention&controldrugresistance,microbialdna,viral/bloodfemalegestationalagehumanhivinfections/blood/congenital/drugtherapy/KWDtransmissionhivseropositivity/blood/congenital/drugtherapy/transmissionKWDhiv-1/drugeffects/isolation&purifinfantinfant,newbornpolymerasechainreactionpregnancypregnancycomplications,infectious/blood/drugtherapy/KWDvirologyprospectivestudiesriskrna,viral/KWDbloodsupport,uKWDsKWDgov't,pKWDhKWDsKWDzidovudine/administration&dosage/KWDtherapeuticusejournalarticlemulticenterstudy
Comment in: JAMA 1996 Feb 28;275(8):640-1
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M9660702

Copyright © 1996 - National Library of Medicine. Reproduced under license with the National Library of Medicine, Bethesda, MD.

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