VERTICAL
TRANSMISSION OF HIV-1: ANTIRETROVIRAL THERAPY AND PROPHYLACTIC MEASURES
Fortuny C1, Jim��nez R1, S��nchez E2,
Lonca M3, Coll O3, Boguñ�� JM1
1Pediatric Integrated Unit HC-HSJD-HCM, Hospital Sant Joan de D��u, 2Catalan
Agency for Health Technology Assessment and Research, 3Hospital
Cl��nic i Provincial. Barcelona, Spain
Objective: To describe the experience in using
antiretrovirals and other prophylactic measures in HIV-1-infected pregnant
women and their newborns at two university hospitals in Barcelona, Spain.
Methods: Prospective study of children born to women with
confirmed HIV-1 infection and exposed to antiretroviral regimens from
October 1, 1994 (implementation of ACTG 076 regimen) to September 30, 2000.
HIV-1 infection in infants was diagnosed according to the 1994 CDC criteria
(evidence of viral genome in two separated blood samples). Children older
than six months with two or more negative DNA-HIV-1 PCR, after the first
month of life, and without clinical manifestations were considered uninfected.
Results: During the study period, 142 infants were
identified (60% of mothers were current or former IV drug users). Four of them became HIV-1 infected
(vertical transmission rate: 3.1%, 95%
Confidence Interval: 0.1% - 6.1%), 126 uninfected and 12 were classified as
exposed. All women received antiretroviral therapy during pregnancy (62
highly active antiretroviral therapy, HAART) and zidovudine (ZDV)
intrapartum. Prophylactic ZDV was administered to all infants. Sixty-two
(44%) infants were delivered by elective cesarean section (CS). Statistical significant differences were found
in gestational age (36.8 wk vs 38
wk, p=0.001), but not in birth weight (2750 g vs 2918 g, p=0.082) between women who received HAART and those
who did not.
Conclusions:
Implementation of prophylactic measures in our setting has reduced HIV-1
vertical transmission rate by 81% (from 16.4% to 3.1%). No infant delivered
by elective CS became infected. Prematurity is more frequent in children
born to mothers treated with HAART.