Document Detail


Missed opportunities for prevention of mother-to-child transmission of HIV-1 in the NISDI Perinatal and LILAC cohorts.
MedLine Citation:
PMID:  22819316     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate cases of mother-to-child transmission of HIV-1 at multiple sites in Latin America and the Caribbean in terms of missed opportunities for prevention.
METHODS: Pregnant women infected with HIV-1 were eligible for inclusion if they were enrolled in either the NISDI Perinatal or LILAC protocols by October 20, 2009, and had delivered a live infant with known HIV-1 infection status after March 1, 2006.
RESULTS: Of 711 eligible mothers, 10 delivered infants infected with HIV-1. The transmission rate was 1.4% (95% CI, 0.7-2.6). Timing of transmission was in utero or intrapartum (n=5), intrapartum (n=2), intrapartum or early postnatal (n=1), and unknown (n=2). Possible missed opportunities for prevention included poor control of maternal viral load during pregnancy; late initiation of antiretrovirals during pregnancy; lack of cesarean delivery before labor and before rupture of membranes; late diagnosis of HIV-1 infection; lack of intrapartum antiretrovirals; and incomplete avoidance of breastfeeding.
CONCLUSION: Early knowledge of HIV-1 infection status (ideally before or in early pregnancy) would aid timely initiation of antiretroviral treatment and strategies designed to prevent mother-to-child transmission. Use of antiretrovirals must be appropriately monitored in terms of adherence and drug resistance. If feasible, breastfeeding should be completely avoided. Presented in part at the XIX International AIDS Conference (Washington, DC; July 22-27, 2012); abstract WEPE163.
Authors:
Jennifer S Read; Rachel A Cohen; Laura Freimanis Hance; Elizabeth S Machado; Marisa M Mussi-Pinhata; Mariana Ceriotto; Breno Santos; Regina Succi; Jose H Pilotto; Jorge O Alarcon; Regis Kreitchmann;
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, N.I.H., Extramural     Date:  2012-07-21
Journal Detail:
Title:  International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics     Volume:  119     ISSN:  1879-3479     ISO Abbreviation:  Int J Gynaecol Obstet     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-09-10     Completed Date:  2013-02-08     Revised Date:  2014-04-08    
Medline Journal Info:
Nlm Unique ID:  0210174     Medline TA:  Int J Gynaecol Obstet     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  70-5     Citation Subset:  IM    
Copyright Information:
Copyright © 2012. Published by Elsevier Ireland Ltd.
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MeSH Terms
Descriptor/Qualifier:
Anti-HIV Agents / therapeutic use
Anti-Retroviral Agents / therapeutic use
Breast Feeding
Caribbean Region
Cesarean Section
Child, Preschool
Cohort Studies
Female
HIV Infections / drug therapy*,  transmission*
HIV-1*
Humans
Infant
Infant, Newborn
Infectious Disease Transmission, Vertical / prevention & control*
Latin America
Pregnancy
Pregnancy Complications, Infectious / drug therapy*,  virology*
Viral Load / drug effects
Grant Support
ID/Acronym/Agency:
HHSN267200800001C//PHS HHS; N01-HD-3-3345/HD/NICHD NIH HHS; N01-HD-8-0001/HD/NICHD NIH HHS
Chemical
Reg. No./Substance:
0/Anti-HIV Agents; 0/Anti-Retroviral Agents
Investigator
Investigator/Affiliation:
Marcelo H Losso / ; Irene Foradori / ; Alejandro Hakim / ; Erica Stankievich / ; Silvina Ivalo / ; Jorge Pinto / ; Victor Melo / ; Fabiana Kakehasi / ; Rosa Dea Sperhacke / ; Nicole Golin / ; Sílvia Mariani Costamilan / ; Jose Pilotto / ; Beatriz Grinsztejn / ; Valdilea Veloso / ; Luis Eduardo Fernandes / ; Gisely Falco / ; Rosa Dea Sperhacke / ; Breno Riegel Santos / ; Rita de Cassia Alves Lira / ; Rosa Dea Sperhacke / ; Mario Ferreira Peixoto / ; Elizabete Teles / ; Regis Kreitchmann / ; Luis Carlos Ribeiro / ; Fabrizio Motta / ; Debora Fernandes Coelho / ; Marisa M Mussi-Pinhata / ; Geraldo Duarte / ; Adriana A Tiraboschi Bárbaro / ; Conrado Milani Coutinho / ; Fabiana Rezende Amaral / ; Anderson Sanches de Melo / ; Ricardo Hugo / ; S Oliveira / ; Elizabeth S Machado / ; Maria C Chermont Sapia / ; Esau Custodio Joao / ; Leon Claude Sidi / ; Maria Leticia Santos Cruz / ; Maria Isabel Gouvêa / ; Ana Paula Antunes / ; Plinio Tostes Berardo / ; Regina Celia de Menezes Succi / ; Prescilla Chow / ; Jorge Alarcón Villaverde / ; Carlos Velásquez Vásquez / ; César Gutiérrez Villafuerte / ; Yolanda Bertucci / ; Laura Freimanis Hance / ; René Gonin / ; D Robert Harris / ; Roslyn Hennessey / ; James Korelitz / ; Margot Krauss / ; Kathryn Miller / ; Sharon Sothern de Sanchez / ; Sonia K Stoszek / ; George K Siberry / ; Rohan Hazra / ; Lynne M Mofenson / ; Jennifer S Read / ; Heather Watts /

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