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http://dx.doi.org/10.3345/kjp.2014.57.3.117

Ten years of experience in the prevention of mother-to-child human immunodeficiency virus transmission in a university teaching hospital  

Park, Jung-Weon (Department of Pediatrics, Korea University College of Medicine)
Yang, Tae-Whan (Department of Pediatrics, Korea University College of Medicine)
Kim, Yun-Kyung (Department of Pediatrics, Korea University College of Medicine)
Choi, Byung-Min (Department of Pediatrics, Korea University College of Medicine)
Kim, Hai-Joong (Department of Internal Medicine, Korea University College of Medicine)
Park, Dae-Won (Department of Obstetrics and Gynecology, Korea University College of Medicine)
Publication Information
Clinical and Experimental Pediatrics / v.57, no.3, 2014 , pp. 117-124 More about this Journal
Abstract
Purpose: Administration of antiretroviral drugs to mothers and infants significantly decreases mother-to-child human immunodeficiency virus (HIV) transmission; cesarean sections and discouraging breastfeeding further decreases this risk. The present study confirmed the HIV status of babies born to mothers infected with HIV and describes the characteristics of babies and mothers who received preventive treatment. Methods: This study retrospectively analyzed medical records of nine infants and their mothers positive for HIV who gave birth at Korea University Ansan Hospital, between June 1, 2003, and May 31, 2013. Maternal parameters, including HIV diagnosis date, CD4+ count, and HIV ribonucleic acid (RNA) copy number, were analyzed. Infant growth and development, HIV RNA copy number, and HIV antigen/antibody test results were analyzed. Results: Eight HIV-positive mothers delivered nine babies; all the infants received antiretroviral therapy. Three (37.5%) and five mothers (62.5%) were administered single- and multidrug therapy, respectively. Intravenous zidovudine was administered to four infants (50%) at birth. Breastfeeding was discouraged for all the infants. All the infants were negative for HIV, although two were lost to follow-up. Third trimester maternal viral copy numbers were less than 1,000 copies/mL with a median CD4+ count of $325{\mu}L$ ($92-729{\mu}L$). Among the nine infants, two were preterm (22.2%) and three had low birth weights (33.3%). Conclusion: This study concludes that prophylactic antiretroviral therapy, scheduled cesarean section, and prohibition of breastfeeding considerably decrease mother-to-child HIV transmission. Because the number of infants infected via mother-to-child transmission may be increasing, studies in additional regions using more variables are necessary.
Keywords
HIV infections; Vertical transmission of infectious disease; Postnatal care; Antiretroviral therapy; Prevention of HIV infections;
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1 Rates of mother-to-child transmission of HIV-1 in Africa, America, and Europe: results from 13 perinatal studies. The Working Group on Mother-To-Child Transmission of HIV. J Acquir Immune Defic Syndr Hum Retrovirol 1995;8:506-10.   DOI   ScienceOn
2 Sperling RS, Shapiro DE, Coombs RW, Todd JA, Herman SA, McSherry GD, et al. Maternal viral load, zidovudine treatment, and the risk of transmission of human immunodeficiency virus type 1 from mother to infant. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J Med 1996;335:1621-9.   DOI   ScienceOn
3 Kliegman RM, Stanton BF, St. Geme JW, Schor NF, Behrman RE. Nelson textbook of pediatrics. 19th ed. Philadelphia: Elsevier, 2011.
4 Lee HJ. Pediatric HIV infection. Korean J Infect Dis 1995;27:425-37.
5 Lindegren ML, Byers RH Jr, Thomas P, Davis SF, Caldwell B, Rogers M, et al. Trends in perinatal transmission of HIV/AIDS in the United States. JAMA 1999;282:531-8.   DOI   ScienceOn
6 Connor EM, Sperling RS, Gelber R, Kiselev P, Scott G, O'Sullivan MJ, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J Med 1994;331:1173-80.   DOI   ScienceOn
7 Zhou Z, Meyers K, Li X, Chen Q, Qian H, Lao Y, et al. Prevention of mother-to-child transmission of HIV-1 using highly active antiretroviral therapy in rural Yunnan, China. J Acquir Immune Defic Syndr 2010;53 Suppl 1:S15-22.
8 Kim HY, Kasonde P, Mwiya M, Thea DM, Kankasa C, Sinkala M, et al. Pregnancy loss and role of infant HIV status on perinatal mortality among HIV-infected women. BMC Pediatr 2012;12:138.   DOI
9 Choe KW. Epidemiology of HIV/AIDS: Current Status, Trend and Prospect. J Korean Med Assoc 2007;50:296-302.   DOI   ScienceOn
10 Centers for Disease Control and Prevention. HIV surveillance report. Atlanta: Centers for Disease Control and Prevention, 2011:1-11.
11 Perinatal HIV Guidelines Working Group. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1 Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmis sion in the United States. April 29, 2009:1-90 [Internet]. Rocville (MD): AIDS Info; c2014 [cited 2013 Jun 30]. Available from: http:// aidsinfo.nih.gov/ContentFiles/PerinatalGL.pdf.
12 Jackson JB, Musoke P, Fleming T, Guay LA, Bagenda D, Allen M, et al. Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: 18-month follow-up of the HIVNET 012 randomised trial. Lancet 2003;362:859-68.   DOI   ScienceOn
13 Tuomala RE, Watts DH, Li D, Vajaranant M, Pitt J, Hammill H, et al. Improved obstetric outcomes and few maternal toxicities are associated with antiretroviral therapy, including highly active antiretroviral therapy during pregnancy. J Acquir Immune Defic Syndr 2005;38:449-73.   DOI   ScienceOn
14 Moodley D, Moodley J, Coovadia H, Gray G, McIntyre J, Hofmyer J, et al. A multicenter randomized controlled trial of nevirapine versus a combination of zidovudine and lamivudine to reduce intrapartum and early postpartum mother-to-child transmission of human immunodeficiency virus type 1. J Infect Dis 2003;187:725-35.   DOI   ScienceOn
15 European Collaborative Study; Swiss Mother and Child HIV Cohort Study. Combination antiretroviral therapy and duration of pregnancy. AIDS 2000;14:2913-20.   DOI   ScienceOn
16 Thorne C, Patel D, Newell ML. Increased risk of adverse pregnancy outcomes in HIV-infected women treated with highly active antiretroviral therapy in Europe. AIDS 2004;18:2337-9.   DOI   ScienceOn
17 Rudin C, Spaenhauer A, Keiser O, Rickenbach M, Kind C, Aebi-Popp K, et al. Antiretroviral therapy during pregnancy and premature birth: analysis of Swiss data. HIV Med 2011;12:228-35.   DOI   ScienceOn
18 Barret B, Tardieu M, Rustin P, Lacroix C, Chabrol B, Desguerre I, et al. Persistent mitochondrial dysfunction in HIV-1-exposed but uninfected infants: clinical screening in a large prospective cohort. AIDS 2003;17:1769-85.   DOI   ScienceOn
19 Soh YM. HIV Infection in Children. J Korean Pediatr Soc 1995;38:1023-35.
20 Centers for Disease Control and Prevention, Center for Infectious Diseases, Division of HIV/AIDS. HIV/AIDS surveillance. Atlanta: Centers for Disease Control and Prevention, Division of HIV/AIDS,1993.
21 Kourtis AP, Lee FK, Abrams EJ, Jamieson DJ, Bulterys M. Motherto- child transmission of HIV-1: timing and implications for prevention. Lancet Infect Dis 2006;6:726-32.   DOI   ScienceOn
22 Coovadia H. Current issues in prevention of mother-to-child transmission of HIV-1. Curr Opin HIV AIDS 2009;4:319-24.   DOI   ScienceOn
23 Mofenson LM. Technical report: perinatal human immunodeficiency virus testing and prevention of transmission. Committee on Pediatric Aids. Pediatrics 2000;106:E88.   DOI   ScienceOn
24 Garcia PM, Kalish LA, Pitt J, Minkoff H, Quinn TC, Burchett SK, et al. Maternal levels of plasma human immunodeficiency virus type 1 RNA and the risk of perinatal transmission. Women and Infants Transmission Study Group. N Engl J Med 1999;341:394-402.   DOI   ScienceOn
25 Read JS, Newell MK. Efficacy and safety of cesarean delivery for prevention of mother-to-child transmission of HIV-1. Cochrane Database Syst Rev 2005;(4):CD005479.
26 European Mode of Delivery Collaboration. Elective caesareansection versus vaginal delivery in prevention of vertical HIV-1 transmission: a randomised clinical trial. Lancet 1999;353:1035-9.   DOI   ScienceOn
27 Landesman SH, Kalish LA, Burns DN, Minkoff H, Fox HE, Zorrilla C, et al. Obstetrical factors and the transmission of human immunodeficiency virus type 1 from mother to child. The Women and Infants Transmission Study. N Engl J Med 1996;334:1617-23.   DOI   ScienceOn
28 Cooper ER, Charurat M, Mofenson L, Hanson IC, Pitt J, Diaz C, et al. Combination antiretroviral strategies for the treatment of pregnant HIV-1-infected women and prevention of perinatal HIV-1 transmission. J Acquir Immune Defic Syndr 2002;29:484-94.   DOI
29 Chung YH, Cho SS. Analysis of HIV/AIDS notifications in Korea, 2011. Public Health Wkly Rep 2012;5:813-8.