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M94A0223.TXT
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1994-10-08
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Document 0223
DOCN M94A0223
TI Maternal predictors of perinatal human immunodeficiency virus
transmission. The New York City Perinatal HIV Transmission Collaborative
Study Group.
DT 9412
AU Thomas PA; Weedon J; Krasinski K; Abrams E; Shaffer N; Matheson P; Bamji
M; Kaul A; Hutson D; Grimm KT; et al; New York City Department of
Health, NY 10013.
SO Pediatr Infect Dis J. 1994 Jun;13(6):489-95. Unique Identifier :
AIDSLINE MED/94359771
AB This analysis sought to identify characteristics of pregnant human
immunodeficiency virus type 1 (HIV-1)-infected women that predict
mother-to-child HIV-1 transmission. Pregnant and immediately postpartum
women at risk for HIV were enrolled at obstetric and pediatric care
settings in New York City from 1986 to 1992. Demographic and behavioral
characteristics, clinical illness, T lymphocyte subsets, immunoglobulin
concentration and syphilis serology were collected on the women. Infants
were followed to determine HIV infection classification according to
Centers for Disease Control and Prevention criteria for HIV-1 in
children. Transmission rates were calculated for women who gave birth
more than 15 months before the analysis. Of 172 HIV-1-infected women
with known outcome 49 (28%) had infected infants. The transmission rate
(TR) was significantly higher among women with < 280 CD4+
cells/microliters (lowest CD4+ quartile) than with CD4+ counts > 280
(48% vs. 22%; P = 0.004; odds ratio, 3.4; 95% confidence interval (1.5,
7.8)); a similar trend was seen by CD4+% quartile. No difference in TR
was seen comparing women by CD8+ count quartile but marginally higher TR
was seen among women with CD8+% > or = 51% than with CD8+% < 51% (TR =
41% vs. 24%; P = 0.076; odds ratio, 2.2; confidence interval (1.0,
5.1)). The highest TR, 62% was seen in women with both CD8+ count above
the median and CD4+ count in the lowest quartile. No significant
difference in TR was seen between women with and without HIV-related
illness, although the TR was 53% among women hospitalized in the
previous year for pneumonia compared with 25% in others (P = 0.03). TR
was somewhat lower in women who delivered by cesarean section than
vaginally (entire cohort: 18% vs. 32%, P = 0.11; prenatal enrollees
only, 17% vs. 38%, P = 0.045). No factor or combination of factors was
both highly sensitive and specific for predicting mother-to-child HIV
transmission. A possible relationship between transmission and mode of
delivery deserves further investigation.
DE Adolescence Adult AIDS Serodiagnosis Cohort Studies CD4-CD8 Ratio
Female Human HIV Core Protein p24/IMMUNOLOGY HIV
Infections/*CONGENITAL/IMMUNOLOGY/*TRANSMISSION *HIV-1/IMMUNOLOGY
Immunoglobulins/IMMUNOLOGY Infant Infant, Newborn Pregnancy
Pregnancy Complications, Infectious/IMMUNOLOGY/*PHYSIOPATHOLOGY
Prospective Studies Risk Factors Support, U.S. Gov't, P.H.S.
T-Lymphocyte Subsets/IMMUNOLOGY JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).