Placental membrane inflammation and risks of maternal-to-child transmission of HIV-1 in Uganda. NLM AIDSLINE Important note: Information in this article was accurate in 2000. The state of the art may have changed since the publication date.

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Placental membrane inflammation and risks of maternal-to-child transmission of HIV-1 in Uganda.

J Acquir Immune Defic Syndr. 1999 Dec 1;22(4):379-85. Unique Identifier : AIDSLINE MED/20097666
Wabwire-Mangen F; Gray RH; Mmiro FA; Ndugwa C; Abramowsky C; Wabinga H; Whalen C; Li C; Saah AJ; Institute of Public Health, Makerere University, Kampala, Uganda.

Abstract: Prospective follow-up of 172 HIV-infected pregnant women and their infants was conducted at Mulago Hospital, Kampala, Uganda during 1990 to 1992. Information was collected on maternal immune status (CD4 counts or clinical AIDS), and concurrent infections with sexually transmitted diseases. Infants were observed on a follow-up basis to determine HIV infection, using polymerase chain reaction (PCR) under 15 months of age and enzyme immunoassay/Western blot for those older than 15 months. Placental membrane inflammation (chorioamnionitis and funisitis), and placental villous inflammation (villitis, intervillitis, and deciduitis) were diagnosed by histopathology. Mother-to-child HIV transmission rates were assessed, and adjusted odds ratios (OR) and 95% confidence intervals (95% CI) of transmission were estimated using women with no placental pathology or evidence of immune suppression as a reference group. RESULTS: The overall mother-to-child HIV transmission rate was 23.3%. Women with no placental membrane inflammation or immune suppression had a transmission rate of 11.3%; compared with 25.5% in women with placental inflammation and no immunosuppression (adjusted OR, 2.87; 95% CI, 1.04-7.90), and 37.0% in immunosuppressed women (OR, 3.07; 95% CI, 1.42-6.67). We estimate that 34% of HIV transmission could be prevented by treatment of placental membrane inflammation in nonimmunocompromised women. Transmission rates were 40.9% with genital ulcer disease (OR, 3.57; 95% CI, 1.28-9.66). Placental villous inflammation and artificial rupture of membranes did not increase transmission rates and cesarean section was associated with a nonsignificant reduction of risk (OR, 0.70; 95% CI 0.24-2.06). CONCLUSION: Placental membrane inflammation increases the rate of mother-to-child HIV transmission.

Keywords: JOURNAL ARTICLE Blotting, Western Chorioamnionitis/COMPLICATIONS/PATHOLOGY *Disease Transmission, Vertical Female Human HIV Infections/COMPLICATIONS/*TRANSMISSION/VIROLOGY *HIV-1/ISOLATION & PURIF Immunocompromised Host Immunoenzyme Techniques Infant Infant, Newborn Inflammation Placenta Diseases/*COMPLICATIONS/PATHOLOGY Polymerase Chain Reaction Pregnancy *Pregnancy Complications, Infectious/VIROLOGY Support, Non-U.S. Gov't Support, U.S. Gov't, P.H.S. Uganda

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A0040854

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