Complex Anti-HIV Therapy Reduces Vertical Transmission Risk
Originally published by Reuters Health, May 17, 2002
NEW YORK (Reuters Health) — The longer and more complex the prenatal antiretroviral therapy, the more likely it is to prevent mother-to-child HIV-1 transmission, researchers report.
Dr. Ellen R. Cooper, from Boston Medical Center, and colleagues collected data on 1542 HIV-1-positive women who had singleton live births between January 1990 and June 2000. The researchers had serial HIV-1 RNA measurements for these women and compared these with the HIV status of their infants.
Among the 396 women who had not received prenatal antiretroviral treatment, the mother-to-child HIV-1 transmission rate was 20.0%, the researchers found.
The HIV-1 transmission rate for the 710 women who had received monotherapy with zidovudine was 10.4%. Among the 186 women who had received dual antiretroviral therapy containing no or only one highly active drug (Multi-ART), the mother-to-child transmission rate was 3.8%.
However, for the 250 women who had received highly active antiretroviral therapy (HAART), the HIV-1 transmission rate was 1.2%, Dr. Cooper's team reports in the April 15th issue of the Journal of Acquired Immune Deficiency Syndromes.
Viral load at the time of delivery was also associated with the HIV-1 transmission rate. For women who received prenatal antiretroviral therapy and had viral loads 400 copies/mL or less, the HIV-1 transmission rate was 1.1%. When viral load was 401 to 3499 copies/mL, the transmission rate was 4.5%. For women with viral loads of 30,000 copies/mL or more, the rate was 17.1%, the investigators add.
After Dr. Cooper's group adjusted the data for maternal viral load, duration of therapy, and other factors, compared with women receiving zidovudine, the odds ratio for transmission for women who received Multi-ART was 0.30, and it was 0.27 for women who had received HAART.
"Of all the factors independently related to the risk of perinatal transmission, perhaps the most modifiable is the use of antiretroviral therapy," Dr. Cooper and colleagues note.
"Our data suggest that use of such therapy, in addition to providing benefit to maternal health, may also result in further reductions in the risk of mother-child transmission. This argues for the critical importance of universal prenatal HIV counseling with voluntary testing," they add.
