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Asymptomatic women at high risk of vertical HIV‐1 transmission to their fetuses
Author(s) -
Tibaldi Cecilia,
Tovo Pier A.,
Ziarati Nahid,
Palomba Elvia,
Salassa Bernardino,
Sciandra Mauro,
D'Ambrosio Rosa,
Ponti Antonio,
Sinicco Alessandro
Publication year - 1993
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.1993.tb12975.x
Subject(s) - asymptomatic , pregnancy , medicine , odds ratio , transmission (telecommunications) , lymphocyte , obstetrics , prospective cohort study , logistic regression , fetus , immunology , pediatrics , biology , genetics , electrical engineering , engineering
Objective To identify how reliably CD4+ (helper) lymphocyte count and p24 antigenaemia can predict mother‐to‐infant transmission of human immunodeficiency virus type 1 (HIV‐1). Design Prospective study. Setting University of Turin Center for Intravenous Drug Users (IVDU) and/or HIV‐1 seropositive pregnant women. Subjects Twenty‐nine infants born to asymptomatic seropositive women from November 1985 to June 1991. Results Seven children (24%) developed symptomatic infection, while 22 healthy seronegative children at the age of 18 months were considered uninfected. A CD4+ lymphocyte count persistently <500/mm 3 during pregnancy was associated significantly with the child's infection status with a relative risk (RR) of 11.4. (CI 1.58–82.05). A marked association (RR 13.6) (CI 1.93–95.72) was similarly detected between maternal antigenaemia and the risk of the child being infected. In a multivariate logistic analysis, crude and adjusted odds ratios (OR) of transmission were 27.0 (95% CI 2.5–291.2) and 35.6 (1.1–1159) for low CD4+ counts; 64 (3.2–1261) and 51.6 (2.5–1058) for p24 antigenaemia. Conclusions Asymptomatic HIV positive women with a CD4+ count below 500/mm 3 or p24 antigenaemia are about ten times as likely to transmit the virus to their children. CD4+ lymphocytes decrease during pregnancy and a low CD4+ cell count early in pregnancy remains low up to delivery. Therefore knowledge that they have a low CD4+ lymphocyte count early in pregnancy may help women to decide whether or not to continue their pregnancy.