The effect of maternal viral load on the risk of perinatal transmission of HIV-1

Donald M. Thea, Richard W. Steketee, Vadim Pliner, Katherine Bornschlegel, Teresa Brown, Sherry Orloff, Pamela B. Matheson, Elaine J. Abrams, Mahrukh Bamji, Genevieve Lambert, Ellie Schoenbaum, Pauline A. Thomas, Margaret Heagarty, Marcia L. Kalish

Research output: Contribution to journalArticle

97 Citations (Scopus)

Abstract

Objective: To determine the effect of maternal viral load at delivery on the risk of perinatal transmission of HIV-1. Design: A nested case-control study within a prospectively followed cohort of HIV-1-infected pregnant women and their infants. Setting: The multicenter New York City Perinatal HIV Transmission Collaborative Study. Participants: Fifty-one women who gave birth to HIV-1-infected infants were frequency-matched within CD4+ cell count quintiles with 54 non-transmitting mothers. Main outcome measures: Maternal quantity of HIV-1 viral RNA was assayed in plasma obtained near delivery using the nucleic acid sequence-based amplification assay system. Results: Viral RNA was detected in 73 (70%) out of 105 women and the median viral load was 16,000 RNA copies/ml in transmitters and 6600 in non-transmitters (P < 0.01). When adjusted for maternal CD4+ count near delivery, women with measurable viral load were nearly sixfold more likely to transmit HIV-1 than women with viral load below detection [adjusted odds ratio (AOR), 5.8; 95% confidence interval (CI), 2.2-15.5]. The odds ratio for perinatal transmission of log10 viral load, adjusted for CD4 count was 2.7 (95% CI, 1.5-5.1). When stratified by the stage of HIV-1 disease, the only group with significant association between log10 viral load and transmission were AIDS-free women with CD4+ count > 500 x 106/l (AOR, 9.1; 95% CI, 2.6-31.5). Conclusions: High maternal viral load increases the likelihood of perinatal transmission of HIV-1 in women without AIDS and advanced immunosuppression. HIV-l-infected pregnant women without advanced disease, shown by others to have the lowest risk of perinatal transmission, may benefit the most from efforts to identify and decrease viral load at delivery.

Original languageEnglish (US)
Pages (from-to)437-444
Number of pages8
JournalAIDS
Volume11
Issue number4
StatePublished - 1997

Fingerprint

Viral Load
HIV-1
Mothers
Viral RNA
Pregnant Women
Self-Sustained Sequence Replication
HIV
CD4 Lymphocyte Count
Immunosuppression
Case-Control Studies
Acquired Immunodeficiency Syndrome
Outcome Assessment (Health Care)
Parturition
RNA

Keywords

  • Children
  • HIV-1
  • Nucleic acid sequence-based amplification
  • Perinatal transmission
  • Viral load

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Thea, D. M., Steketee, R. W., Pliner, V., Bornschlegel, K., Brown, T., Orloff, S., ... Kalish, M. L. (1997). The effect of maternal viral load on the risk of perinatal transmission of HIV-1. AIDS, 11(4), 437-444.

The effect of maternal viral load on the risk of perinatal transmission of HIV-1. / Thea, Donald M.; Steketee, Richard W.; Pliner, Vadim; Bornschlegel, Katherine; Brown, Teresa; Orloff, Sherry; Matheson, Pamela B.; Abrams, Elaine J.; Bamji, Mahrukh; Lambert, Genevieve; Schoenbaum, Ellie; Thomas, Pauline A.; Heagarty, Margaret; Kalish, Marcia L.

In: AIDS, Vol. 11, No. 4, 1997, p. 437-444.

Research output: Contribution to journalArticle

Thea, DM, Steketee, RW, Pliner, V, Bornschlegel, K, Brown, T, Orloff, S, Matheson, PB, Abrams, EJ, Bamji, M, Lambert, G, Schoenbaum, E, Thomas, PA, Heagarty, M & Kalish, ML 1997, 'The effect of maternal viral load on the risk of perinatal transmission of HIV-1', AIDS, vol. 11, no. 4, pp. 437-444.
Thea DM, Steketee RW, Pliner V, Bornschlegel K, Brown T, Orloff S et al. The effect of maternal viral load on the risk of perinatal transmission of HIV-1. AIDS. 1997;11(4):437-444.
Thea, Donald M. ; Steketee, Richard W. ; Pliner, Vadim ; Bornschlegel, Katherine ; Brown, Teresa ; Orloff, Sherry ; Matheson, Pamela B. ; Abrams, Elaine J. ; Bamji, Mahrukh ; Lambert, Genevieve ; Schoenbaum, Ellie ; Thomas, Pauline A. ; Heagarty, Margaret ; Kalish, Marcia L. / The effect of maternal viral load on the risk of perinatal transmission of HIV-1. In: AIDS. 1997 ; Vol. 11, No. 4. pp. 437-444.
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abstract = "Objective: To determine the effect of maternal viral load at delivery on the risk of perinatal transmission of HIV-1. Design: A nested case-control study within a prospectively followed cohort of HIV-1-infected pregnant women and their infants. Setting: The multicenter New York City Perinatal HIV Transmission Collaborative Study. Participants: Fifty-one women who gave birth to HIV-1-infected infants were frequency-matched within CD4+ cell count quintiles with 54 non-transmitting mothers. Main outcome measures: Maternal quantity of HIV-1 viral RNA was assayed in plasma obtained near delivery using the nucleic acid sequence-based amplification assay system. Results: Viral RNA was detected in 73 (70{\%}) out of 105 women and the median viral load was 16,000 RNA copies/ml in transmitters and 6600 in non-transmitters (P < 0.01). When adjusted for maternal CD4+ count near delivery, women with measurable viral load were nearly sixfold more likely to transmit HIV-1 than women with viral load below detection [adjusted odds ratio (AOR), 5.8; 95{\%} confidence interval (CI), 2.2-15.5]. The odds ratio for perinatal transmission of log10 viral load, adjusted for CD4 count was 2.7 (95{\%} CI, 1.5-5.1). When stratified by the stage of HIV-1 disease, the only group with significant association between log10 viral load and transmission were AIDS-free women with CD4+ count > 500 x 106/l (AOR, 9.1; 95{\%} CI, 2.6-31.5). Conclusions: High maternal viral load increases the likelihood of perinatal transmission of HIV-1 in women without AIDS and advanced immunosuppression. HIV-l-infected pregnant women without advanced disease, shown by others to have the lowest risk of perinatal transmission, may benefit the most from efforts to identify and decrease viral load at delivery.",
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T1 - The effect of maternal viral load on the risk of perinatal transmission of HIV-1

AU - Thea, Donald M.

AU - Steketee, Richard W.

AU - Pliner, Vadim

AU - Bornschlegel, Katherine

AU - Brown, Teresa

AU - Orloff, Sherry

AU - Matheson, Pamela B.

AU - Abrams, Elaine J.

AU - Bamji, Mahrukh

AU - Lambert, Genevieve

AU - Schoenbaum, Ellie

AU - Thomas, Pauline A.

AU - Heagarty, Margaret

AU - Kalish, Marcia L.

PY - 1997

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N2 - Objective: To determine the effect of maternal viral load at delivery on the risk of perinatal transmission of HIV-1. Design: A nested case-control study within a prospectively followed cohort of HIV-1-infected pregnant women and their infants. Setting: The multicenter New York City Perinatal HIV Transmission Collaborative Study. Participants: Fifty-one women who gave birth to HIV-1-infected infants were frequency-matched within CD4+ cell count quintiles with 54 non-transmitting mothers. Main outcome measures: Maternal quantity of HIV-1 viral RNA was assayed in plasma obtained near delivery using the nucleic acid sequence-based amplification assay system. Results: Viral RNA was detected in 73 (70%) out of 105 women and the median viral load was 16,000 RNA copies/ml in transmitters and 6600 in non-transmitters (P < 0.01). When adjusted for maternal CD4+ count near delivery, women with measurable viral load were nearly sixfold more likely to transmit HIV-1 than women with viral load below detection [adjusted odds ratio (AOR), 5.8; 95% confidence interval (CI), 2.2-15.5]. The odds ratio for perinatal transmission of log10 viral load, adjusted for CD4 count was 2.7 (95% CI, 1.5-5.1). When stratified by the stage of HIV-1 disease, the only group with significant association between log10 viral load and transmission were AIDS-free women with CD4+ count > 500 x 106/l (AOR, 9.1; 95% CI, 2.6-31.5). Conclusions: High maternal viral load increases the likelihood of perinatal transmission of HIV-1 in women without AIDS and advanced immunosuppression. HIV-l-infected pregnant women without advanced disease, shown by others to have the lowest risk of perinatal transmission, may benefit the most from efforts to identify and decrease viral load at delivery.

AB - Objective: To determine the effect of maternal viral load at delivery on the risk of perinatal transmission of HIV-1. Design: A nested case-control study within a prospectively followed cohort of HIV-1-infected pregnant women and their infants. Setting: The multicenter New York City Perinatal HIV Transmission Collaborative Study. Participants: Fifty-one women who gave birth to HIV-1-infected infants were frequency-matched within CD4+ cell count quintiles with 54 non-transmitting mothers. Main outcome measures: Maternal quantity of HIV-1 viral RNA was assayed in plasma obtained near delivery using the nucleic acid sequence-based amplification assay system. Results: Viral RNA was detected in 73 (70%) out of 105 women and the median viral load was 16,000 RNA copies/ml in transmitters and 6600 in non-transmitters (P < 0.01). When adjusted for maternal CD4+ count near delivery, women with measurable viral load were nearly sixfold more likely to transmit HIV-1 than women with viral load below detection [adjusted odds ratio (AOR), 5.8; 95% confidence interval (CI), 2.2-15.5]. The odds ratio for perinatal transmission of log10 viral load, adjusted for CD4 count was 2.7 (95% CI, 1.5-5.1). When stratified by the stage of HIV-1 disease, the only group with significant association between log10 viral load and transmission were AIDS-free women with CD4+ count > 500 x 106/l (AOR, 9.1; 95% CI, 2.6-31.5). Conclusions: High maternal viral load increases the likelihood of perinatal transmission of HIV-1 in women without AIDS and advanced immunosuppression. HIV-l-infected pregnant women without advanced disease, shown by others to have the lowest risk of perinatal transmission, may benefit the most from efforts to identify and decrease viral load at delivery.

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KW - Nucleic acid sequence-based amplification

KW - Perinatal transmission

KW - Viral load

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