Update of Perinatal Human Immunodeficiency Virus Type 1 Transmission in France: Zero Transmission for 5482 Mothers on Continuous Antiretroviral Therapy From Conception and With Undetectable Viral Load at Delivery

Jeanne Sibiude^{1

2}, Jérôme Le Chenadec³, Laurent Mandelbrot², Alexandre Hoctin³, Catherine Dollfus⁴, Albert Faye^{5

6}, Eida Bui⁷, Emmanuelle Pannier⁸, Jade Ghosn⁹, Valerie Garrait¹⁰, Véronique Avettand-Fenoel^{11

12}, Pierre Frange¹³, Josiane Warszawski^{14

15}, Roland Tubiana^{16

17}

Affiliations

¹ Department of Gynecology-Obstetrics, Assistance Publique des Hôpitaux de Paris Hôpital Louis Mourier, Colombes, France.
² Université de Paris, Infection, Antimicrobials, Modelling, Evolution UMR 1137, Institut national de la santé et de la recherche médicale, Paris, France.
³ Institut national de la santé et de la recherche médicale Centre d'Epidémiologie et de Santé des Populations U1018, Le Kremlin-Bicêtre, France.
⁴ Department of Pediatric Hematology-oncology, Assistance Publique des Hôpitaux de Paris Hôpital Trousseau, Paris, France.
⁵ Department of Pediatrics and Infectious Diseases, Assistance Publique des Hôpitaux de Paris Hôpital Robert Debré, Paris, France.
⁶ Université de Paris, Institut national de la santé et de la recherche médicale, U1123, Paris, France.
⁷ Department of Gynécology-Obstetrics, Assistance Publique des Hôpitaux de Paris Hôpital Trousseau, Paris, France.
⁸ Department of Gynecology and Obstetrics, Assistance Publique des Hôpitaux de Paris, Maternité Port Royal, Paris, France.
⁹ Department of Infectious and Tropical Diseases, Assistance Publique des Hôpitaux de Paris, Nord, Hôpital Bichat - Claude Bernard, Paris, France.
¹⁰ Department of infectious diseases, Centre Hospitalier inter-communal de Créteil, Créteil, France.
¹¹ Department of Clinical Microbiology, Assistance Publique des Hôpitaux de Paris Hôpital Necker-Enfants Malades, Université de Paris, Paris, France.
¹² Institut national de la santé et de la recherche médicale U1016, Centre national de la recherche scientifique UMR8104, Institut Cochin, Paris, France.
¹³ EHU 7328 PACT, Institut Imagine, Université de Paris, Paris, France.
¹⁴ Department of Epidemiology and Public Health, Assistance Publique des Hôpitaux de Paris Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
¹⁵ Université Paris-Saclay, Institut national de la santé et de la recherche médicale Centre d'Epidémiologie et de Santé des Populations U1018, Le Kremlin-Bicêtre, France.
¹⁶ Department of Infectious and Tropical Diseases, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France.
¹⁷ Institut national de la santé et de la recherche médicale, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.

PMID: 36037040
DOI: 10.1093/cid/ciac703

Multicenter Study

Update of Perinatal Human Immunodeficiency Virus Type 1 Transmission in France: Zero Transmission for 5482 Mothers on Continuous Antiretroviral Therapy From Conception and With Undetectable Viral Load at Delivery

Jeanne Sibiude et al. Clin Infect Dis. 2023.

. 2023 Feb 8;76(3):e590-e598.

doi: 10.1093/cid/ciac703.

Authors

Affiliations

¹ Department of Gynecology-Obstetrics, Assistance Publique des Hôpitaux de Paris Hôpital Louis Mourier, Colombes, France.
² Université de Paris, Infection, Antimicrobials, Modelling, Evolution UMR 1137, Institut national de la santé et de la recherche médicale, Paris, France.
³ Institut national de la santé et de la recherche médicale Centre d'Epidémiologie et de Santé des Populations U1018, Le Kremlin-Bicêtre, France.
⁴ Department of Pediatric Hematology-oncology, Assistance Publique des Hôpitaux de Paris Hôpital Trousseau, Paris, France.
⁵ Department of Pediatrics and Infectious Diseases, Assistance Publique des Hôpitaux de Paris Hôpital Robert Debré, Paris, France.
⁶ Université de Paris, Institut national de la santé et de la recherche médicale, U1123, Paris, France.
⁷ Department of Gynécology-Obstetrics, Assistance Publique des Hôpitaux de Paris Hôpital Trousseau, Paris, France.
⁸ Department of Gynecology and Obstetrics, Assistance Publique des Hôpitaux de Paris, Maternité Port Royal, Paris, France.
⁹ Department of Infectious and Tropical Diseases, Assistance Publique des Hôpitaux de Paris, Nord, Hôpital Bichat - Claude Bernard, Paris, France.
¹⁰ Department of infectious diseases, Centre Hospitalier inter-communal de Créteil, Créteil, France.
¹¹ Department of Clinical Microbiology, Assistance Publique des Hôpitaux de Paris Hôpital Necker-Enfants Malades, Université de Paris, Paris, France.
¹² Institut national de la santé et de la recherche médicale U1016, Centre national de la recherche scientifique UMR8104, Institut Cochin, Paris, France.
¹³ EHU 7328 PACT, Institut Imagine, Université de Paris, Paris, France.
¹⁴ Department of Epidemiology and Public Health, Assistance Publique des Hôpitaux de Paris Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
¹⁵ Université Paris-Saclay, Institut national de la santé et de la recherche médicale Centre d'Epidémiologie et de Santé des Populations U1018, Le Kremlin-Bicêtre, France.
¹⁶ Department of Infectious and Tropical Diseases, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France.
¹⁷ Institut national de la santé et de la recherche médicale, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.

PMID: 36037040
DOI: 10.1093/cid/ciac703

Abstract

Background: Antiretroviral therapy (ART) is remarkably effective in preventing perinatal transmission (PT) of HIV-1. We evaluated the PT rate in a population of women with widespread access to ART before conception.

Methods: The analysis included 14 630 women with HIV-1 who delivered from 2000 to 2017 at centers participating in the nationwide prospective multicenter French Perinatal Cohort (ANRS-EPF). PT was analyzed according to time period, timing of ART initiation, maternal plasma viral load (pVL), and gestational age at birth. No infants were breastfed, and all received neonatal prophylaxis.

Results: PT decreased between 3 periods, from 1.1% in 2000-2005 (58/5123) to 0.7% in 2006-2010 (30/4600) and to 0.2% in 2011-2017 (10/4907; P < .001). Restriction of the analysis to the 6316/14 630 (43%) women on ART at conception, PT decreased from 0.42% (6/1434) in 2000-2005 to 0.03% (1/3117) in 2011-2017 (P = .007). Among women treated at conception, if maternal pVL was undetectable near delivery, no PT was observed regardless of the ART combination [95%CI 0-0.07] (0/5482). Among women who started ART during pregnancy and with undetectable pVL near delivery, PT was 0.57% [95%CI 0.37-0.83] (26/4596). Among women treated at conception but with a detectable pVL near delivery, PT was 1.08% [95%CI 0.49-2.04] (9/834). We also qualitatively described 10 cases of transmission that occurred during the 2011-2017 period.

Conclusions: In a setting with free access to ART, monthly pVL assessment, infant ART prophylaxis, and in the absence of breastfeeding, suppressive ART initiated before pregnancy and continued throughout pregnancy can reduce PT of HIV to almost zero.

Keywords: HIV-1 perinatal transmission; antiretroviral therapy; plasma viral load monitoring; pregnancy; prevention of perinatal transmission.

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Conflict of interest statement

Potential conflicts of interest. C. D. reports support for attending meetings and/or travel from ViiV Healthcare for conference on retroviruses and opportunistic infections registration fees. P. F. reports grants or contracts and participation on a data and safety monitoring board or advisory board from ANRS-MIE; consulting fees from MSD France and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events and support for attending meetings and/or travel from MSD France, Gilead Sciences, ViiV Healthcare, Bristol Myers Squibb, and Janssen Cilag. J. G. reports grants or contracts from ViiV Healthcare and Gilead Sciences (paid to institution) and consulting fees from ViiV Healthcare, Gilead, MSD France, Astra Zeneca, Theratechnologies, and Janssen (paid to author). J. W. reports an academic grant from INSERM-ANRS and support for attending meetings and/or travel from INSERM-ANRS (academic grant). V. A.-F. reports grants or contracts from ANRS, MSD Avenir Foundation, and ViiV Healthcare (paid to institution); payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Gilead and ViiV Healthcare (paid to author); and support for attending meeting and/or travel from ViiV Healthcare (paid to author). All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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Update of Perinatal Human Immunodeficiency Virus Type 1 Transmission in France: Zero Transmission for 5482 Mothers on Continuous Antiretroviral Therapy From Conception and With Undetectable Viral Load at Delivery

Affiliations

Update of Perinatal Human Immunodeficiency Virus Type 1 Transmission in France: Zero Transmission for 5482 Mothers on Continuous Antiretroviral Therapy From Conception and With Undetectable Viral Load at Delivery

Authors

Affiliations

Abstract

Conflict of interest statement

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical