Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2017 Apr;129(4):621-628.
doi: 10.1097/AOG.0000000000001929.

Missed Opportunities for Prevention of Mother-to-Child Transmission of Human Immunodeficiency Virus

Gwendolyn B Scott  1 , Susan B Brogly, Daniel Muenz, Alice M Stek, Jennifer S Read; International Maternal Pediatric Adolescent AIDS Clinical Trials Group (IMPAACT) P1025 Study Team
Affiliations
Clinical Trial

Missed Opportunities for Prevention of Mother-to-Child Transmission of Human Immunodeficiency Virus

Gwendolyn B Scott et al. Obstet Gynecol. 2017 Apr.

Abstract

Objective: To identify missed opportunities for prevention of mother-to-child transmission of human immunodeficiency virus (HIV).

Methods: Data regarding HIV-infected children born between 2002 and 2009 to HIV-infected women enrolled in the U.S. International Maternal Pediatric Adolescent AIDS Clinical Trials prospective cohort study (protocol P1025) were reviewed. The characteristics of the HIV-infected infants and their mothers and the mothers' clinical management are described.

Results: Twelve cases of mother-to-child transmission of HIV occurred among 1,857 liveborn neonates, for a prevalence of 0.65 per 100 live births to HIV-infected women (95% confidence interval 0.33-1.13). Four transmissions occurred in utero, three were peripartum transmissions, and the timing of transmission for five neonates was unable to be determined. None were breastfed. Seven women had plasma viral loads greater than 400 copies/mL near delivery. Six women had less than 11 weeks of antiretroviral therapy during pregnancy; three of these women had premature deliveries. One woman received no antiretroviral therapy during pregnancy because she was diagnosed with HIV postpartum. Six had poor to moderate adherence to antiretroviral therapy. Four of the five mothers with viral loads greater than 1,000 copies/mL delivered preterm neonates. There were five women who delivered by cesarean; four were nonelective cesarean deliveries and only one was an elective cesarean delivery for HIV prevention.

Conclusion: Despite access to high-level care and follow-up, a small proportion of HIV-infected women transmitted the virus to their neonates. This case series provides insight into factors contributing to HIV perinatal transmission and can inform the development of new strategies for prevention of mother-to-child transmission of HIV.

Clinical trial registration: ClinicalTrials.gov, https://clinicaltrials.gov, NCT00028145.

PubMed Disclaimer

Conflict of interest statement

Financial Disclosure

The authors did not report any potential conflicts of interest.

References

    1. Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States August 6, 2015: Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/Perinatal GL.pdf Accessed October 15, 2016.
    1. Centers for Disease Control and Prevention (CDC). Achievements in public health. Reduction in perinatal transmission of HIV infection--United States, 1985–2005. Morb Mortal Wkly Rep 2006; 55(21):592–7. - PubMed
    1. Connor EM, Sperling RS, Gelber R, Kiselev P, Scott G, O’Sullivan MJ, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. N Engl J Med 1994; 331(18):1173–80. - PubMed
    1. Dorenbaum A, Cunningham CK, Gelber RD, Culnane M; Mofenson L; Britto P, et al. Two-dose intrapartum/newborn nevirapine and standard antiretroviral therapy to reduce perinatal HIV transmission; a randomized trial. JAMA; 2002; 288:189–98. - PubMed
    1. Cooper ER, Charurat M, Mofenson LM, Hanson IC, Pitt J, Diaz C, et al. Combination antiretroviral strategies for the treatment of pregnant HIV-1- infected women and prevention of perinatal HIV-1 transmission. J Acquir Immune Defic Syndr 2002;29(5):484–94. - PubMed

Publication types

MeSH terms

Substances

Associated data