Influence of highly active antiretroviral treatment (HAART) on risk factors for vertical HIV transmission

• Published in: Acta obstetricia et gynecologica Scandinavica Vol. 88; no. 8; pp. 882 - 887
• Main Authors: Garcia-Tejedor, Amparo, Maiques, Vicente, Perales, Alfredo, López-Aldeguer, Jose
• Format: Journal Article
• Language: English
• Published: Oxford, UK Informa UK Ltd 01.01.2009; Blackwell Publishing Ltd; Blackwell
• Subjects: Adult; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral Therapy, Highly Active; Antiviral agents; Biological and medical sciences; CD4 Lymphocyte Count; Cohort Studies; Female; Gynecology. Andrology. Obstetrics; HAART; high-risk pregnancy; HIV; HIV Infections - epidemiology; HIV Infections - prevention & control; HIV Infections - transmission; Human viral diseases; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical - prevention & control; Infectious diseases; Logistic Models; Medical sciences; Pharmacology. Drug treatments; Pregnancy; Pregnancy Complications, Infectious - epidemiology; Pregnancy Complications, Infectious - prevention & control; Retrospective Studies; Risk Factors; vertical transmission; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral Load; Immunopathology; High risk; Gynecology; Retroviridae; AIDS; Maternal diseases; Immune deficiency; Lentivirus; Obstetrics; Infection; Virus; Pregnancy; Chemotherapy; Treatment; HIV; Viral disease; Risk factor; Antiviral; Vertical transmission; Human immunodeficiency virus; HAART; high-risk pregnancy
• ISSN: 0001-6349; 1600-0412
• DOI: 10.1080/00016340903062836

Objective. To analyze the influence of highly active antiretroviral treatment (HAART) on risk factors for perinatal transmission of human immunodeficiency virus (HIV). Design. A prospective cohort study was performed between HIV pregnant women under HAART therapy and without treatment. Setting. The maternity hospital 'La Fe' in Valencia, Spain. Population or sample. Five hundred HIV-positive pregnant women. Method. Known maternal and obstetrical perinatal risk factors were analyzed by univariate and multivariate methods (logistic regression). The influence of HAART on the risk factors was evaluated independently to determine whether there was a modulation in perinatal HIV transmission. Main outcome measures. Known perinatal risk factors were found not to have any significant influence on perinatal HIV transmission in women under HAART therapy. Results. Vertical transmission risk decreased significantly from 18.2% without treatment to 8.6% with mono/dual therapy and 0.6% with HAART. A CD4+ cell count below 500 cell/µl, intrapartum use of invasive procedures, rupture of membranes >six hours, labor length >five hours, and birthweight were the significant risk factors associated to vertical HIV transmission and elective cesarean section. Antiretroviral treatment administered during delivery was a protective factor in HIV pregnant women before HAART therapy. Conclusions. HAART therapy reduces the influence of the perinatal risk factors on vertical HIV transmission.