The Ariel Project: A Prospective Cohort Study of Maternal-Child Transmission of Human Immunodeficiency Virus Type 1 in the Era of Maternal Antiretroviral Therapy

• Published in: The Journal of infectious diseases Vol. 179; no. 2; pp. 319 - 328
• Main Authors: Van Dyke, Russell B., Korber, Bette T., Popek, Edwina, Macken, Catherine, Widmayer, Susan M., Bardeguez, Arlene, Hanson, I. Celine, Wiznia, Andrew, Luzuriaga, Katherine, Viscarello, Richard R., Wolinsky, Steven
• Format: Journal Article
• Language: English
• Published: Chicago, IL University Chicago Press 01.02.1999; University of Chicago Press; Oxford University Press
• Subjects: Acquired Immunodeficiency Syndrome - drug therapy; Acquired Immunodeficiency Syndrome - transmission; Adult; AIDS/HIV; Biological and medical sciences; Chorioamnionitis; Cohort Studies; Disease transmission; Female; Fetal Blood - virology; Histology; HIV 1; HIV-1 - classification; Human viral diseases; Humans; Infant, Newborn; Infants; Infections; Infectious Disease Transmission, Vertical; Infectious diseases; Major Articles; Medical sciences; Multivariate Analysis; Phylogeny; Placenta - pathology; Placenta - virology; Polymerase chain reaction; Pregnancy; Prospective Studies; Risk Factors; Vagina - virology; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viruses; Women; Chorioamnionitis; Pregnancy disorders; HIV-1 virus; Fetal diseases; Delivery disorders; Antiviral; Female; Viral load; Pyrimidine nucleoside; Human; Immunopathology; Retroviridae; AIDS; Immune deficiency; Lentivirus; Placenta diseases; Infection; Virus; Pregnancy; Chemotherapy; Newborn; Treatment; Viral disease; Dideoxynucleoside; Risk factor; Vertical transmission; Human immunodeficiency virus; Detection; Zidovudine
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1086/314580

In a prospective cohort study, clinical and biologic factors that contribute to maternal-child transmission of human immunodeficiency virus type 1 (HIV-1) were studied. HIV-infected pregnant women and their infants were evaluated prospectively according to a standardized protocol. Of 204 evaluable women, 81% received zidovudine during their pregnancy. The infection rate among the 209 evaluable infants was 9.1%. By univariate analysis, histologic chorioamnionitis, prolonged rupture of membranes, and a history of genital warts were significantly associated with transmission. Additional factors associated with transmission that approached significance included a higher maternal virus load at delivery and the presence of cocaine in the urine. In a logistic regression model, histologic chorioamnionitis was the only independent predictor of transmission. Despite a significantly higher transmission rate at one site, no unique viral genotype was found at any site. Thus, chorioamnionitis was found to be the major risk factor for transmission among women receiving zidovudine.