Important note: Information in this article was accurate in December 2000. The state of the art may have changed since the publication date.
Reducing the risk of transmitting HIV from mother to child can be achieved by taking the following steps:
By combining all of these measures, the risk of mother-to-child HIV transmission can be reduced to as little as 1%.
Pregnant HIV positive women in North America and Western Europe are increasingly using combination anti-HIV therapy. Both doctors and mothers are concerned about the potential impact of these medications on the health of the fetus. To study this issue, researchers across Western Europe have been monitoring nearly 4,000 HIV positive mothers and their children. According to the researchers, those women who took protease inhibitors (PIs) were twice as likely to have premature births as compared to women who did not use PIs. Pregnant women who had fewer than 200 CD4+ cells or who used heroin/methadone were also at high risk for giving birth to a premature infant.
Researchers collected information on 3,920 mothers and their children. Only 896 women (23%) received anti-HIV therapy. Of those women, 64% received AZT alone. Of the 323 women taking combination anti-HIV therapy, 41% received AZT and ddI. The most commonly used protease inhibitor was nelfinavir (Viracept).
The viral load of the mothers was not associated with giving birth prematurely. The following factors were, however, linked to premature births:
In the following groups, the proportion of premature births were as follows:
Mothers who used combination therapy that included a PI were 2½ times as likely to give birth to a premature infant compared to mothers who did not use a PI.
Those women who were at highest risk for giving birth to premature infants fell into the following groups:
Women who began combination therapy with or without a PI before pregnancy were twice as likely to give birth to a premature infant than were women who started combination therapy in the third trimester.
According to the researchers, infants that were born were generally not underweight. Moreover, the type of anti-HIV therapy used by the mother during pregnancy did not affect the baby's birth weight. No data on birth defects or other complications were released by the researchers.
1. The European collaborative study and the Swiss mother + child HIV cohort study. AIDS 2000;14(18):2913-2920.
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