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Clin Infect Dis. 2015 Dec 1;61(11):1715-25. doi: 10.1093/cid/civ578. Epub 2015 Jul 21.

No perinatal HIV-1 transmission from women with effective antiretroviral therapy starting before conception.

Collaborators (248)

Mandelbrot L, Crenn-Hebert C, Floch-Tudal C, Mazy F, Joras M, Meier F, Mortier E, Ceccaldi PF, Banige M, Uludag AV, Zarouk V, Lefort A, Hittinger G, Chamouilli JM, Burle C, Lafeuillade A, Medus M, Bachelard G, Dendale-Nguyen J, Guimard T, Guimard K, Brossier JP, Perré P, Esnault JL, Stragier OB, Leautez-Nainville S, Martha SA, Martha B, Maurel E, Françoise M, Barat M, Murger P, Rouha M, Lumbroso P, Checoury A, Perfezou P, Blondin G, Ansart S, De Saint Martin L, Le Moine P, Daniel C, Calvez C, Boutard E, Arvieux C, Bauville E, Dupre C, Poinsignon Y, Grelier A, Mousset G, Cudeville C, Niault M, Belzic I, Moreau P, Le Coz MF, Vaillant OL, Vitrat V, Tardif D, Gaillat J, Vanderbergh A, Braig S, Dehlinger-Paul M, Mohamed K, Heller-Roussin B, Winter C, Firtion G, Pannier E, Costa M, Launay O, Ceron DS, Matheron S, Rajguru M, Elaoun N, Allal L, Azria E, Moine AB, Garrait V, Hau I, Touboul C, Ratsimbazafy L, Kommé C, Elharrar B, Labaune JM, Cotte L, Rudigoz RC, Elleau C, Runel-Belliard C, Pistone T, Muanza B, Broustal E, Duval-Arnould M, Carpentier B, Dienga E, Partisani M, Entz-Werle N, David E, Rey D, Seaume H, Ducrocq S, Bailly-Salin P, Tricoire J, Berrebi A, Cayla C, Chacé A, Metheron I, Boutemy A, Armangaud D, Couderc S, Routier C, Alissa A, Questiaux E, Zakaria A, Dauphin H, Goissen C, Belloy M, Delassus JL, Partisani M, Cheneau C, Lang JM, Brault D, Allisy C, Lebrette MG, Selleret L, Hervé F, Bolot P, Khuong-Josses MA, Ekoukou D, Bounan S, Blanche S, Lemercier D, Frange P, Veber F, Fisher A, Granier M, Devidas A, Nguyen R, May A, Chabrol A, Chevojon P, Moussa ZA, Pluchart C, Rouger C, Tubiana R, Bonmarchand M, Shneider L, Caby F, Calin RO, Coursol A, Chambrin V, Labrune P, Clech L, Pauly-Ravelly I, Moalim R, Sanchez L, Johnson A, Lachassine E, Benoist L, Jeantils V, Gaudelus J, Benbara A, Borgne A, Karaoui L, Elbert VL, Bongain A, Monpoux F, Deville A, Galiba E, Doumet A, Schmidt JL, Cravello L, Hubert C, Dollfus C, Hervé F, Tabone MD, Courcoux MF, Leverger G, Carbonne B, Pinquier D, Clavier B, Pinto-Cardoso G, Faye A, Matheron S, Levine M, Marouts EB, Borie C, Boissinot C, Peretti D, Fourcade C, Chirouze C, Mauvais CH, Reliquet V, Brunet-Cartier C, Winer N, Vaucel E, Briandet C, Brouard J, Demersay AC, Hentgen V, Messaoudi F, Bernard L, Maakroun Z, Nau P, Kebaïli K, Billiemaz K, Abrudan R, Fialaire P, Sentilhes L, Proust S, Arsac P, Mesnard L, Werner E, Ciraru-Vigneron N, Mouchnino G, Ayral D, Vintejoux E, Lalande M, Reynes J, Segondy M, De Gennes C, Clavel C, Mazingue F, Hammou Y, Ajana F, Hatchuel Y, Nahri I, Genet C, Ducroix-Roubert S, Aubrard Y, Constanty A, Weinbreck P, Piet E, Jacquier F, Michau C, Safwan H, Boutet A, Abdelhadi M, Elenga N, Blanche S, Delmas S, Dollfus C, Faye A, Frange P, Le Chenadec J, Mandelbrot L, Perilhou A, Rouzioux C, Sibiude J, Tubiana R, Warszawski J.

Author information

1
Obstetrics-Gynecology Department, Hôpital Louis Mourier, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Colombes CESP, INSERM U1018 Université Paris Diderot Risks in Pregnancy University Department.
2
Infectious Diseases Department, Hôpital Pitié Salpétrière and Université Pierre et Marie Curie INSERM- UMR_S 943 Pierre Louis Institute of Epidemiology and Public Health.
3
CESP, INSERM U1018.
4
Pediatric Hemato-Oncology Department, Hôpital Trousseau.
5
Université Paris Diderot Infectious Diseases Department, Bichat-Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine.
6
Risks in Pregnancy University Department, Obstetrics-Gynecology Department, Hôpital Cochin Port Royal.
7
Université Paris Diderot Pediatrics Department, Hôpital Robert Debré
8
Infectious Diseases Department, Hôpital Delafontaine, Saint Denis.
9
Internal Medicine Department, Hôpital Intercommunal de Créteil.
10
Infectious Diseases Department, Centre Hospitalier Universitaire de Nantes.
11
Infectious Diseases Department, Hôpital Sud Francilien, Evry.
12
Obstetrics-Gynecology Department, Centre Hospitalier Universitaire de Toulouse, Maternité Paule de Viguier.
13
Pediatrics Department, Hôpital d'Argenteuil.
14
Pediatrics Department, Centre Hospitalier Universitaire de Bordeaux.
15
Infectious Diseases Department, Centre Hospitalier Universitaire de Rennes, France.
16
EA 3610 INSERM Virology Laboratory.
17
CESP, INSERM U1018 Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris Université Paris Sud, Le Kremlin-Bicêtre.
18
EA Pharmacologie, INSERM, Université Paris Descartes, Sorbonne Paris-Cité Pediatric Immunology Department, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris.

Abstract

BACKGROUND:

The efficacy of preventing perinatal transmission (PT) of human immunodeficiency virus type 1 (HIV-1) depends on both viral load (VL) and treatment duration. The objective of this study was to determine whether initiating highly active antiretroviral therapy (ART) before conception has the potential to eliminate PT.

METHODS:

A total of 8075 HIV-infected mother/infant pairs included from 2000 to 2011 in the national prospective multicenter French Perinatal Cohort (ANRS-EPF) received ART, delivered live-born children with determined HIV infection status, and did not breastfeed. PT was analyzed according to maternal VL at delivery and timing of ART initiation.

RESULTS:

The overall rate of PT was 0.7% (56 of 8075). No transmission occurred among 2651 infants born to women who were receiving ART before conception, continued ART throughout the pregnancy, and delivered with a plasma VL <50 copies/mL (upper 95% confidence interval [CI], 0.1%). VL and timing of ART initiation were independently associated with PT in logistic regression. Regardless of VL, the PT rate increased from 0.2% (6 of 3505) for women starting ART before conception to 0.4% (3 of 709), 0.9% (24 of 2810), and 2.2% (23 of 1051) for those starting during the first, second, or third trimester (P < .001). Regardless of when ART was initiated, the PT rate was higher for women with VLs of 50-400 copies/mL near delivery than for those with <50 copies/mL (adjusted odds ratio, 4.0; 95% CI, 1.9-8.2).

CONCLUSIONS:

Perinatal HIV-1 transmission is virtually zero in mothers who start ART before conception and maintain suppression of plasma VL.

KEYWORDS:

HIV; antiretroviral therapy; mother-to-child transmission; pregnancy; treatment as prevention

PMID:
26197844
DOI:
10.1093/cid/civ578
[Indexed for MEDLINE]

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