No Perinatal HIV-1 Transmission From Women With Effective Antiretroviral Therapy Starting Before Conception
Laurent Mandelbrot,Roland Tubiana,Jérôme Le Chenadec,Catherine Dollfus,Albert Faye,Emmanuelle Pannier,Sophie Matheron,Marie-Aude Khuong,Valérie Garrait,Véronique Reliquet,Alain Devidas,Alain Berrebi,Christine Allisy,Christophe Elleau,Cédric Arvieux,Christine Rouzioux,Josiane Warszawski,Stéphane Blanche +17 more
TLDR
Perinatal HIV-1 transmission is virtually zero in mothers who start ART before conception and maintain suppression of plasma VL.Abstract:
BACKGROUND The efficacy of preventing perinatal transmission (PT) of human immunodeficiency virus type 1 (HIV-1) depends on both viral load (VL) and treatment duration. The objective of this study was to determine whether initiating highly active antiretroviral therapy (ART) before conception has the potential to eliminate PT. METHODS A total of 8075 HIV-infected mother/infant pairs included from 2000 to 2011 in the national prospective multicenter French Perinatal Cohort (ANRS-EPF) received ART, delivered live-born children with determined HIV infection status, and did not breastfeed. PT was analyzed according to maternal VL at delivery and timing of ART initiation. RESULTS The overall rate of PT was 0.7% (56 of 8075). No transmission occurred among 2651 infants born to women who were receiving ART before conception, continued ART throughout the pregnancy, and delivered with a plasma VL <50 copies/mL (upper 95% confidence interval [CI], 0.1%). VL and timing of ART initiation were independently associated with PT in logistic regression. Regardless of VL, the PT rate increased from 0.2% (6 of 3505) for women starting ART before conception to 0.4% (3 of 709), 0.9% (24 of 2810), and 2.2% (23 of 1051) for those starting during the first, second, or third trimester (P < .001). Regardless of when ART was initiated, the PT rate was higher for women with VLs of 50-400 copies/mL near delivery than for those with <50 copies/mL (adjusted odds ratio, 4.0; 95% CI, 1.9-8.2). CONCLUSIONS Perinatal HIV-1 transmission is virtually zero in mothers who start ART before conception and maintain suppression of plasma VL.read more
Citations
More filters
Journal ArticleDOI
Timing of initiation of antiretroviral therapy and adverse pregnancy outcomes : a systematic review and meta-analysis
Olalekan A. Uthman,Olalekan A. Uthman,Olalekan A. Uthman,Jean B. Nachega,Jean B. Nachega,Jean B. Nachega,Jean Anderson,Steve Kanters,Edward J Mills,Francoise Renaud,Shaffiq Essajee,Meg Doherty,Meg Doherty,Lynne M. Mofenson +13 more
TL;DR: Women who started ART before conception were significantly more likely to deliver preterm or very preterm, or to have low-birthweight infants than were those who began ART after conception, and the risk of very low birthweight, small for gestational age, stillbirth, and congenital anomalies did not differ significantly.
Journal ArticleDOI
Challenges in the Elimination of Pediatric HIV-1 Infection
TL;DR: Progress in preventing mother-to-child transmission of HIV-1 requires a series of steps in the care of women and their infants during pregnancy, delivery, and the postpartum period and is summarized in resource-limited countries and elsewhere.
Journal ArticleDOI
Primary Care Guidance for Persons With Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America.
Melanie A. Thompson,Michael A. Horberg,Allison L. Agwu,Jonathan Colasanti,Mamta K. Jain,William R. Short,Tulika Singh,Judith A. Aberg +7 more
TL;DR: Advances in antiretroviral therapy have made it possible for persons with HIV to live a near expected life span, without progressing to AIDS or transmitting HIV to sexual partners or infants, so comprehensive evidence-based HIV primary care guidance is more important than ever.
Journal ArticleDOI
HIV viraemia and mother-to-child transmission risk after antiretroviral therapy initiation in pregnancy in Cape Town, South Africa.
Landon Myer,Tamsin K Phillips,James McIntyre,Nei-yuan Hsiao,Gregory Petro,Allison Zerbe,Jordache Ramjith,Linda-Gail Bekker,Elaine J. Abrams +8 more
TL;DR: Maternal HIV viral load (VL) drives mother‐to‐child HIV transmission (MTCT) risk but there are few data from sub‐Saharan Africa, where most MTCT occurs.
Journal ArticleDOI
HIV treatment in pregnancy
TL;DR: The biological mechanisms that underlie observed associations between antenatal ART and adverse outcomes in pregnancy and birth are not completely understood and further research needed as well as strengthening of the systems to assess safety of antiretroviral drugs for the mother and HIV-exposed child.
References
More filters
Journal ArticleDOI
Prevention of HIV-1 Infection with Early Antiretroviral Therapy
Myron S. Cohen,Ying Q. Chen,Marybeth McCauley,Theresa Gamble,Mina C. Hosseinipour,Nagalingeswaran Kumarasamy,James Hakim,Johnstone Kumwenda,Beatriz Grinsztejn,José Henrique Pilotto,Sheela Godbole,Sanjay Mehendale,Suwat Chariyalertsak,Breno Santos,Kenneth H. Mayer,Irving F. Hoffman,Susan H. Eshleman,Estelle Piwowar-Manning,Lei Wang,Joseph Makhema,Lisa A. Mills,Guy de Bruyn,Ian Sanne,Joseph J. Eron,Joel E. Gallant,Diane V. Havlir,Susan Swindells,Heather J. Ribaudo,Vanessa Elharrar,David N. Burns,Taha E. Taha,Karin Nielsen-Saines,David D. Celentano,Myron Essex,Thomas R. Fleming +34 more
TL;DR: In this article, Antiretroviral therapy that reduces viral replication could limit the transmission of human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples.
Journal ArticleDOI
Prevention of HIV-1 infection with early antiretroviral therapy
TL;DR: The exciting evidence generated by this paper – that antiretroviral treatment of HIV-1 infection definitively reduces the risk of onward transmission of the virus by 96% – was rightly dubbed Science magazine's ‘Breakthrough of the Year’ in 2011.
Journal ArticleDOI
Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group.
Edward M. Connor,Rhoda S. Sperling,Richard D. Gelber,Pavel Kiselev,Gwendolyn B. Scott,Mary Jo O'Sullivan,Russell Vandyke,Mohammed Bey,William T. Shearer,Robert L. Jacobson,Eleanor Jimenez,Edward O’neill,Brigitte Bazin,Jean François Delfraissy,Mary Culnane,Robert W. Coombs,Mary Elkins,Jack Moye,Pamela Stratton,James Balsley +19 more
TL;DR: In pregnant women with mildly symptomatic HIV disease and no prior treatment with antiretroviral drugs during the pregnancy, a regimen consisting of zidovudine given ante partum and intra partum to the mother and to the newborn for six weeks reduced the risk of maternal-infant HIV transmission by approximately two thirds.
Journal ArticleDOI
Combination antiretroviral strategies for the treatment of pregnant HIV-1-infected women and prevention of perinatal HIV-1 transmission.
Ellen R. Cooper,Manhattan Charurat,Lynne M. Mofenson,I. Celine Hanson,Jane Pitt,Clemente Diaz,Karen C. Hayani,Edward Handelsman,Vincent Smeriglio,Rodney Hoff,William A. Blattner +10 more
TL;DR: Levels of HIV-1 RNA at delivery and prenatal antiretroviral therapy were independently associated with transmission and the protective effect of therapy increased with the complexity and duration of the regimen.
Journal ArticleDOI
A prospective study of infants born to women seropositive for human immunodeficiency virus type 1.
Stéphane Blanche,Christine Rouzioux,M. L.G. Moscato,F Veber,M. J. Mayaux,C Jacomet,J Tricoire,A. Deville,M Vial,Ghislaine Firtion +9 more
TL;DR: It is concluded that approximately one third of the infants born to seropositive mothers will have evidence of HIV-1 infection or of AIDS by the age of 18 months, and that about one fifth of this group will have died.
Related Papers (5)
Prevention of HIV-1 Infection with Early Antiretroviral Therapy
Myron S. Cohen,Ying Q. Chen,Marybeth McCauley,Theresa Gamble,Mina C. Hosseinipour,Nagalingeswaran Kumarasamy,James Hakim,Johnstone Kumwenda,Beatriz Grinsztejn,José Henrique Pilotto,Sheela Godbole,Sanjay Mehendale,Suwat Chariyalertsak,Breno Santos,Kenneth H. Mayer,Irving F. Hoffman,Susan H. Eshleman,Estelle Piwowar-Manning,Lei Wang,Joseph Makhema,Lisa A. Mills,Guy de Bruyn,Ian Sanne,Joseph J. Eron,Joel E. Gallant,Diane V. Havlir,Susan Swindells,Heather J. Ribaudo,Vanessa Elharrar,David N. Burns,Taha E. Taha,Karin Nielsen-Saines,David D. Celentano,Myron Essex,Thomas R. Fleming +34 more
Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group.
Edward M. Connor,Rhoda S. Sperling,Richard D. Gelber,Pavel Kiselev,Gwendolyn B. Scott,Mary Jo O'Sullivan,Russell Vandyke,Mohammed Bey,William T. Shearer,Robert L. Jacobson,Eleanor Jimenez,Edward O’neill,Brigitte Bazin,Jean François Delfraissy,Mary Culnane,Robert W. Coombs,Mary Elkins,Jack Moye,Pamela Stratton,James Balsley +19 more
Mother-to-child HIV transmission despite antiretroviral therapy in the ANRS French Perinatal Cohort.
Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy
Alison Rodger,Valentina Cambiano,Tina Bruun,Pietro Vernazza,Simon Collins,Jan van Lunzen,Giulio Maria Corbelli,Vicente Estrada,Anna Maria Geretti,Apostolos Beloukas,David Asboe,Pompeyo Viciana,Félix Gutiérrez,Bonaventura Clotet,Christian Pradier,Jan Gerstoft,Rainer Weber,Katarina Westling,Gilles Wandeler,Jan M. Prins,Armin Rieger,Marcel Stoeckle,Tim Kümmerle,Teresa Bini,Adriana Ammassari,Richard Gilson,Ivanka Krznaric,Matti Ristola,Robert Zangerle,Pia Handberg,Antonio Antela,Sris Allan,Andrew N. Phillips,Jens D Lundgren +33 more