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Clinical Trial
. 2012 Oct;119(1):70-5.
doi: 10.1016/j.ijgo.2012.05.026. Epub 2012 Jul 21.

Missed opportunities for prevention of mother-to-child transmission of HIV-1 in the NISDI Perinatal and LILAC cohorts

Jennifer S Read  1 , Rachel A Cohen, Laura Freimanis Hance, Elizabeth S Machado, Marisa M Mussi-Pinhata, Mariana Ceriotto, Breno Santos, Regina Succi, Jose H Pilotto, Jorge O Alarcon, Regis Kreitchmann; NISDI Perinatal/LILAC Study Group
Collaborators, Affiliations
Clinical Trial

Missed opportunities for prevention of mother-to-child transmission of HIV-1 in the NISDI Perinatal and LILAC cohorts

Jennifer S Read et al. Int J Gynaecol Obstet. 2012 Oct.

Abstract

Objective: To evaluate cases of mother-to-child transmission of HIV-1 at multiple sites in Latin America and the Caribbean in terms of missed opportunities for prevention.

Methods: Pregnant women infected with HIV-1 were eligible for inclusion if they were enrolled in either the NISDI Perinatal or LILAC protocols by October 20, 2009, and had delivered a live infant with known HIV-1 infection status after March 1, 2006.

Results: Of 711 eligible mothers, 10 delivered infants infected with HIV-1. The transmission rate was 1.4% (95% CI, 0.7-2.6). Timing of transmission was in utero or intrapartum (n=5), intrapartum (n=2), intrapartum or early postnatal (n=1), and unknown (n=2). Possible missed opportunities for prevention included poor control of maternal viral load during pregnancy; late initiation of antiretrovirals during pregnancy; lack of cesarean delivery before labor and before rupture of membranes; late diagnosis of HIV-1 infection; lack of intrapartum antiretrovirals; and incomplete avoidance of breastfeeding.

Conclusion: Early knowledge of HIV-1 infection status (ideally before or in early pregnancy) would aid timely initiation of antiretroviral treatment and strategies designed to prevent mother-to-child transmission. Use of antiretrovirals must be appropriately monitored in terms of adherence and drug resistance. If feasible, breastfeeding should be completely avoided. Presented in part at the XIX International AIDS Conference (Washington, DC; July 22-27, 2012); abstract WEPE163.

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References

    1. Read JS, Duarte G, Freimanis Hance L, Pinto J, Gouvea MI, Cohen RA, et al. The NICHD International Site Development Initiative perinatal cohorts (2002-09) Int J Epidemiol. 2011:1–8. - PMC - PubMed
    1. D'Ippolito M, Read JS, Korelitz J, João EC, Mussi-Pinhata M, Rocha N, et al. Missed opportunities for prevention of mother-to-child transmission of human immunodeficiency virus type 1 in Latin America and the Caribbean: the NISDI perinatal study. Pediatr Infect Dis J. 2007;26(7):649–53. - PubMed
    1. Ministry of Health, Peru Guidelines for prevention of mother-to-child transmission of HIV and congenital syphilis. NTS N° 064-2008-MINSA/DGSP-V.01. ftp://ftp2.minsa.gob.pe/normaslegales/2008/RM335-2008.pdf. Published May 20, 2008. Accessed March 27, 2012.
    1. Ministry of Health, Argentina Prevention of mother-to-child transmission of syphilis, hepatitis B, and HIV: Recommendations for the work of health teams –2012. http://www.msal.gov.ar/sida/pddf/info-equipos-salud/2012-guia-tv.pdf. Accessed June 23, 2012.
    1. Ministry of Health, Brazil Recommendations for prevention of mother-to-child transmission of HIV and antiretroviral therapy during pregnancy. http://www.aids.gov.br/sites/default/files/consenso_gestantes_2010_vf.pdf. Published 2010. Accessed March 27, 2012.

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