Perinatal transmission of HIV-1 in a resources limited population from Buenos Aires city, Argentina: impact of preterm birth and absence of maternal/intrapartum prophylaxis
D.M. Cecchini, M. Martinez, R. Giesolauro, V. Astarita, C.F. Nieto, C. Rodriguez
Hospital Cosme Argerich, Working Group in Prevention of HIV Mother-to-Child Transmission, Buenos Aires, Argentina
Background: Perinatal transmission (PT) is the main cause of pediatric HIV-infection in Latin America. Identification of variables associated with PT is of importance to improve local policies for preventing mother-to-child transmission
Methods: Data regarding HIV+ pregnant women (HPW) and their newborns assisted at the “Cosme Argerich” Hospital, Buenos Aires city (CABA), Argentina were prospectively collected (period 1998-2008). Univariate analyses were done to identify independent variables associated with PT (table 1). Variables with a significance level of p < 0.05 were considered for the logistic regression (LR) analysis.
Results: We evaluated 357 mother-child binomium. Overall perinatal transmission: 3.2%. Univariate analyses are detailed in table 1.
[Perinatal transmission: univariate analysis]
|Variable||Odds Ratio [OR]||95% CI||P|
|Peripartum HIV-1 viral load >1000/mL or unknown||8.97||1.13 - 71.0||0.02|
|Maternal CD4 T-cell count <200/μL||0.48||0.02 - 7.89||1.00|
|Vaginal delivery||3.66||0.92 - 14.47||0.10|
|Preterm birth||7.01||1.65 - 29.72||0.01|
|Maternal hepatitis C coinfection||0.51||0.06 - 4.26||0.84|
|Absence of maternal/intrapatum prophylaxis||29.69||6.04 - 145.86||<0.001|
|Low birth weight||2.40||0.59 - 9.68||0.40|
|Membrane rupture >4 hours||2.70||0.31- 23.43||0.89|
In the LR analysis, absence of maternal and intrapatum components of PACTG 076 (OR: 17.49, 95% CI: 2.15-142.23) and preterm birth (OR: 11.63, 95% CI:1.64-82.34) remained associated with PT (p = 0.007 and 0.01, respectively).
Conclusions: Incomplete access to PACTG 076 components constitutes a major factor for PT among a resources limited population of an important urban area, despite available resources. Action must be taken to improve access of HPW to the public health system. Of note, preterm birth was not identified as a risk factor for mother-to-child transmission in previous analysis from Ministry of Health of CABA (XVII International AIDS Conference, Abstract no. CDC0317).
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