التفاصيل البيبلوغرافية
| العنوان: |
Identification of levels of maternal HIV-1 RNA associated with risk of perinatal transmission. Effect of maternal zidovudine treatment on viral load. |
| المؤلفون: |
Dickover RE, Garratty EM, Herman SA, Sim M, Plaeger S, Boyer PJ, Keller M, Deveikis A, Stiehm R, Bryson YJ, Dickover, R E, Garratty, E M, Herman, S A, Sim, M S, Plaeger, S, Boyer, P J, Keller, M, Deveikis, A, Stiehm, E R, Bryson, Y J |
| المصدر: |
JAMA: Journal of the American Medical Association; 2/28/96, Vol. 275 Issue 8, p599-605, 7p |
| مستخلص: |
Objective: To determine if there are levels of human immunodeficiency virus type 1 (HIV-1) associated with a high or low risk of perinatal transmission and to ascertain the mechanism by which zidovudine treatment reduces perinatal transmission.Design: A nonrandomized prospective cohort study.Setting: University medical center and two general hospital affiliates from May 1989 to September 1994.Patients: Ninety-two HIV-1-seropositive women (95 pregnancies) and their 97 infants.Intervention: Forty-two mothers (43 pregnancies) received zidovudine therapy during pregnancy and/or during labor and delivery. Eleven infants received prophylactic zidovudine for the first 6 weeks after delivery.Main Outcome Measure: HIV-1 infection status of the infant.Results: Twenty of the 97 infants were perinatally infected with HIV-1. Transmitting mothers were more likely to have plasma HIV-1 RNA levels higher than 50000 copies per milliliter at delivery than nontransmitting mothers (15 [75.0%] of 20 transmitters vs four [5.3%] of 75 nontransmitters; P < .001). None of the 63 women with less than 20000 HIV-1 RNA copies per milliliter transmitted. Twenty-two women treated with open-label oral zidovudine during gestation showed an eightfold median decrease in plasma RNA levels (median [25th and 75th percentile], 43043 [5699 and 63053] copies per milliliter before zidovudine vs 4238 [603 and 5116] HIV-1 RNA copies per milliliter at delivery; P < .001) and none transmitted. Four zidovudine-treated women with high HIV-1 levels transmitted despite the presence of zidovudine-sensitive virus in vitro in both the mothers and their infants.Conclusions: Maternal HIV-1 RNA levels were highly predictive of perinatal transmission risk and suggest that certain levels of virus late in gestation and/or during labor and delivery are associated with both a high risk and a low risk of transmission. Our results also suggest that zidovudine exerts a major protective effect by reducing maternal HIV-1 RNA levels prior to delivery and that further strategies are needed to prevent perinatal transmission in women with high or increasing virus levels and/or zidovudine-resistant virus. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
Complementary Index |
