Document 0223
 DOCN  M94A0223
 TI    Maternal predictors of perinatal human immunodeficiency virus
       transmission. The New York City Perinatal HIV Transmission Collaborative
       Study Group.
 DT    9412
 AU    Thomas PA; Weedon J; Krasinski K; Abrams E; Shaffer N; Matheson P; Bamji
       M; Kaul A; Hutson D; Grimm KT; et al; New York City Department of
       Health, NY 10013.
 SO    Pediatr Infect Dis J. 1994 Jun;13(6):489-95. Unique Identifier :
       AIDSLINE MED/94359771
 AB    This analysis sought to identify characteristics of pregnant human
       immunodeficiency virus type 1 (HIV-1)-infected women that predict
       mother-to-child HIV-1 transmission. Pregnant and immediately postpartum
       women at risk for HIV were enrolled at obstetric and pediatric care
       settings in New York City from 1986 to 1992. Demographic and behavioral
       characteristics, clinical illness, T lymphocyte subsets, immunoglobulin
       concentration and syphilis serology were collected on the women. Infants
       were followed to determine HIV infection classification according to
       Centers for Disease Control and Prevention criteria for HIV-1 in
       children. Transmission rates were calculated for women who gave birth
       more than 15 months before the analysis. Of 172 HIV-1-infected women
       with known outcome 49 (28%) had infected infants. The transmission rate
       (TR) was significantly higher among women with < 280 CD4+
       cells/microliters (lowest CD4+ quartile) than with CD4+ counts > 280
       (48% vs. 22%; P = 0.004; odds ratio, 3.4; 95% confidence interval (1.5,
       7.8)); a similar trend was seen by CD4+% quartile. No difference in TR
       was seen comparing women by CD8+ count quartile but marginally higher TR
       was seen among women with CD8+% > or = 51% than with CD8+% < 51% (TR =
       41% vs. 24%; P = 0.076; odds ratio, 2.2; confidence interval (1.0,
       5.1)). The highest TR, 62% was seen in women with both CD8+ count above
       the median and CD4+ count in the lowest quartile. No significant
       difference in TR was seen between women with and without HIV-related
       illness, although the TR was 53% among women hospitalized in the
       previous year for pneumonia compared with 25% in others (P = 0.03). TR
       was somewhat lower in women who delivered by cesarean section than
       vaginally (entire cohort: 18% vs. 32%, P = 0.11; prenatal enrollees
       only, 17% vs. 38%, P = 0.045). No factor or combination of factors was
       both highly sensitive and specific for predicting mother-to-child HIV
       transmission. A possible relationship between transmission and mode of
       delivery deserves further investigation.
 DE    Adolescence  Adult  AIDS Serodiagnosis  Cohort Studies  CD4-CD8 Ratio
       Female  Human  HIV Core Protein p24/IMMUNOLOGY  HIV
       Infections/*CONGENITAL/IMMUNOLOGY/*TRANSMISSION  *HIV-1/IMMUNOLOGY
       Immunoglobulins/IMMUNOLOGY  Infant  Infant, Newborn  Pregnancy
       Pregnancy Complications, Infectious/IMMUNOLOGY/*PHYSIOPATHOLOGY
       Prospective Studies  Risk Factors  Support, U.S. Gov't, P.H.S.
       T-Lymphocyte Subsets/IMMUNOLOGY  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).