HIV reduced vertical transmission intrapartum

The mother-child transmission of the AIDS virus (HIV) tends to decrease, particularly through the use of cesarean limit transmission during childbirth, according to a study published in the journal "JAIDS".

In utero transmission

Dr. Laurence S. Magder, the department of epidemiology and preventive medicine at the University of Maryland, and colleagues analyzed data from the study WITS (Women and infants transmission study), a prospective, multicenter, longitudinal who began in 1989.

The transmission was defined as having occurred in utero, that is to say during pregnancy if the tests performed in the child tested positive within 48 hours after birth and during delivery (intrapartum) if they became positive only during the first week.

From 1990 to 2001, 1797 children are born to HIV-positive (HIV +). The viral status could be determined for 1709 of them: in fact, 9.7% were infected. This rate has decreased over time, from 18.1% in 1990-1992 to 1.6% in 1999-2000.

Caesarean section reduces the risk of intrapartum transmission

Of the 166 HIV + children, the authors estimate that 33.7% were infected in utero and 66.3% at delivery.

If the proportion of transmission in utero is the lowest, it tends to increase due to the greater reduction of intrapartum transmission.

Finally, the rate of transmission in utero decreased less (4.9% in 1993-1994 vs. 1.6% in 1999-2001) the rate of intrapartum transmission (13.9% vs. 0.5% in 1990-1992 to 1999-2001).

The administration of antiretroviral therapy during labor and especially the wider voluntary Caesarean section, since the recommendations made in 1999 by the American College of Obstetricians and Gynecologists for HIV + women with a viral load greater than 1,000 copies / ml, explain the favorable intrapartum transmission.

Intrapartum transmission was significantly associated with the duration of rupture of the placental membrane, the authors say, where the interests of cesarean that occurs before this step.

Recommendations to reduce the risk in utero

Risk factors for in utero transmission include maternal use of hard drugs, viral load and antiretroviral therapy, the authors write.

"These data suggest that interventions to reduce vertical transmission should include screening for HIV infection before or early in pregnancy, improving access to treatment for addicted women and early initiation highly active antiretroviral therapy during pregnancy in order to best limit the replication of HIV, "they conclude.