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Chapter 13 : Human Immunodeficiency Virus Infection and Pregnancy

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Human Immunodeficiency Virus Infection and Pregnancy, Page 1 of 2

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Abstract:

This chapter familiarizes clinicians with the literature regarding outcomes of pregnancies of human immunodeficiency virus (HIV)-infected women, and describes strategies to minimize transmission and to reduce the frequency of adverse perinatal outcomes. Pregnant women with a high viral load, revealed by high titers of HIV or p24 antigenemia, apparently are a group at particularly high risk of transmission. Acute viremia associated with maternal seroconversion in the year prior to pregnancy or during breast-feeding appears to be associated with increased rates of vertical transmission. Intensive exposure of the infant’s thin skin or mucosal surfaces to maternal blood and secretions during the birth process could provide a significant route for virus transmission. Advanced immunologic deterioration, as demonstrated by decreased numbers of circulating CD4 lymphocytes, has been associated with an increased risk of vertical transmission. Over the last several years, a great deal has been learned about the timing of transmission. There are no data to support antepartum, intrapartum, and neonatal (breast-feeding) transmission of HIV. Most reports from developed countries suggest that, other than transmission of HIV infection, pregnancy outcomes are not affected by serostatus, at least in asymptomatic patients. Women who choose to maintain their pregnancy should be aware that certain interventions may reduce the risk of perinatal HIV transmission and that several other approaches are under study to determine whether they will have additional benefit. The single most important step in prenatal care today is the use of zidovudine (ZDV) in the antepartum, intrapartum, and neonatal periods.

Citation: Minkoff H. 1999. Human Immunodeficiency Virus Infection and Pregnancy, p 225-243. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch13
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References

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1. Allain, J. P.,, T. Matthew,, R. Coombs, et al. 1991. Antibody to V3 loop does not predict vertical transmission of HIV, abstr. W. C. 2263. In Proceedings of the VII International Conference on AIDS.
2. Baba, T. W.,, J. Koch,, E., S. Mittler, M. Greene, M. Wyand, D. Pennick, and R. M. Rupect. 1994. Mucosal infection of neonatal rhesus monkeys with cell-free SIV. AIDS Res. Hum. Retroviruses 10:351357.
3. Belec, L.,, D. Meillet,, O. Gaillard,, T. Prazuck,, E. Michel,, J. Ngondi Ekome,, and J. Pillot. 1995. Decreased cervicovaginal production of both IgA1 and IgA2 sub-classes in women with AIDS. Clin. Exp. Immunol. 101:100106.
4. Blanche, S.,, C. Rouzioux,, M.-L. Guihart Moscato,, F. Veber,, M. J. Mayaux,, C. Ja-comet,, J. Tricoire,, A. Deville,, M. Vial,, and G. Firtion. 1989. A prospective study of infants born to women seropositive for human immunodeficiency virus type 1. N. Engl. J. Med. 320:16431648.
5. Blanche, S.,, M. J. Mayaux,, C. Rouzioux,, J. P. Teglas,, G. Firtion,, F. Monpoux,, N. Ciraru-Vigneron,, F. Meier,, J. Tricoire,, and C. Courpotin. 1994. Relation of the course of HIV infection in children to the severity of the disease in their mothers at delivery. N. Engl. J. Med. 330:308312.
6. Borkowski, W.,, K. Drazinski,, D. Paul,, R. Holzman,, T. Moore,, P. Bebenroth,, R. Lawrence,, and S. Chandwani. 1989. Human immunodeficiency virus type 1 an-tigenemia in children. J. Pediatr. 114:940945.
7. Boue, F.,, J. C. Pons,, L. Keros, et al. 1990. Risk for HIV-1 perinatal transmission vary with the mother’s stage of HIV infection, abstr. Th. C44. In Proceedings of the VI International Conference on AIDS.
8. Broliden, P. A.,, V. Moschese,, K. Ljungren,, J. Rosen,, C. Fundaro,, A. Plebani,, M. Jondal,, P. Ross,, and B. Wahren. 1989. Diagnostic implications of specific immunoglobulin G patterns born to HIV infected women. AIDS 3:577582.
9. Bryson, E.,, K. Luzuriaga,, J. L. Sullivan,, and D. Ware. 1992. Proposed definition for in-utero versus intrapartum transmission of HIV-1. N. Engl. J. Med. 327:12461247.
10. Burns, D. N.,, S. Landesman,, L. R. Muenz,, R. P. Nugent,, J. J. Goedert,, H. Minkoff,, J. H. Walsh,, H. Mendez,, A. Rubinstein,, and A. Willoughby. 1994. Cigarette smoking, premature rupture of membranes and vertical transmission of HIV-1 among women with low CD4+levels. J. Acquired Immune Defic. Syndr. 7:718726.
11. Chin, J. 1991. Current and future dimension of the HIV/AIDS pandemic in women and children. Lancet 336:221224.
12. Connor, E. M.,, R. S. Sperling,, R. Gelber,, P. Kiselev,, G. Scott,, M. J. O’Sullivan,, R. Van Dyke,, M. Bey,, W. Shearer,, and R. L. Jacobsen. 1994. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. N. Engl. J. Med. 331:11731180.
13. Cotton, P. 1994. Trial halted after drug cuts maternal HIV transmission rate by two thirds. JAMA 271:807.
14. Courgnaud, V.,, F. Laure,, F. Barin, et al. 1989. In utero HIV-1 transmission identified through PCR, abstr. MBP-1. In Proceedings of the V International Conference on AIDS.
15. Courpotin, C.,, G. Israel,, D. Dubeaux,, G. Vogt,, H. di Maria,, F. Bricout,, and D. Dormont. 1988. Predictive value of HIV replication in cell culture in babies born to seropositive mothers. Lancet ii:10741074.
16. D’Arminio, M. A.,, M. Ravizza,, M. L. Muggiasca, et al. 1991. HIV-infected pregnant women: possible predictors of vertical transmission, abstr. W.C. 49. In Proceedings of the VII International Conference on AIDS.
17. DeFasio, K.,, J. J. Kelly,, J. Beuhler,, B. M. Whyte,, E. D. Mokotoff,, C. E. Bell,, W. Brandon,, B. L. Nahlen,, A. F. Phelps,, J. H. Stephens,, A. J. Davidson,, and H. L. Minkoff. 1992. Provision of gynecologic care at outpatient medical facilities serv-ing HIV infected persons. Am. J. Women’s Health 1:193196.
18. Devash, Y.,, T. Calvelli,, D. G. Wood,, R. J. Reagen,, and A. Rubinstein. 1990. Vertical transmission of HIV is correlated with absence of high affinity/avidity maternal antibodies to the gp120 principal neutralizing domain. Proc. Natl. Acad. Sci. USA 87:345349.
19. Dickover, R. E.,, E. M. Garraty,, S. A. Hermann,, M. S. Sim,, S. Plaeger,, P. J. Boyer,, M. Keller,, A. Deveikis,, E. R. Steihm,, and Y. J. Bryson. 1996. Identification of levels of HIV-1 RNA associated with risk of perinatal transmission: effect of ma-ternal zidovudine treatment on viral load. JAMA 275:599605.
20. Dunn, D. T.,, N. L. Newell,, A. E. Ades,, and C. S. Peckham. 1992. Risk of human immunodeficiency virus type 1 transmission through breastfeeding. Lancet 340: 585588.
21. Ehrnst, A.,, S. Lindgren,, M. Dictor,, B. Johansson,, A. Sonnerborg,, J. Cjakowski,, G. Sundin,, and A. B. Bohlin. 1991. HIV in pregnant women and their offspring: evidence for late transmission. Lancet 338:203207.
22. European Collaborative Study. 1991. Children born to women with HIV-1 infection: natural history and risk of transmission. Lancet 337:253260.
23. European Collaborative Study. 1992. Risk factors for mother to child transmission of HIV-1. Lancet 339:10071012.
24. Fang, G.,, H. Burger,, R. Grimson,, P. Tropper,, S. Nachman,, D. Mayers,, O. Weislow,, R. Moore,, C. Reyelt,, and N. Hutcheon. 1995. Maternal plasma human immunodeficiency virus type 1 RNA level: a determinant and projected threshold for mother-to-child transmission. Proc. Natl. Acad. Sci. USA 92:1210012104.
25. Fazely, F.,, P. L. Sharma,, C. Fratazzi,, M. F. Greene,, M. S. Wyand,, M. A. Mermon,, D. Pennick,, and R. M. Ruprect. 1993. Simian immunodeficiency virus infection via amniotic fluid: a model to study fetal immunopathogenesis and prophylaxis. J. Acquired Immune Defic. Syndr. 6:107114.
26. Friedland, G. H.,, B. R. Saltzman,, M. F. Rogers,, P. A. Kahl,, M. L. Leser,, M. M. Mayers,, and R. S. Klein. 1986. Lack of transmission of HTLV111/LAV infection to household contacts of patients with AIDS or ARC with oral candidiasis. N. Engl. J. Med. 314:3444.
27. Gabiano, C.,, P. Tovo,, M. de Martino,, L. Galli,, C. Giaquinto,, A. Loy,, M. C. Schoeller,, M. Giovannini,, G. Ferranti,, and L. Rancilo. 1992. Mother to child transmission of HIV 1: risk of infection and correlates of transmission. Pediatrics 90:362374.
28. Goedert, J. J.,, H. Mendez,, J. E. Drummond,, M. Robert-Guroff,, H. L. Minkoff,, S. Holman,, S. Stevens,, A. Rubinstein,, W. A. Blattner,, and A. Willoughby. 1989. Mother-to-infant transmission of HIV type 1: association with prematurity or low anti-gp120. Lancet iii:13511354.
29. Goedert, J. J.,, A. M. Duliege,, C. I. Amos,, S. Felton,, and R. J. Biggar. 1991. High risk of HIV-1 infection for first born twins. Lancet 338:1471⋙̸1475.
30. Hague, R. A.,, J. Y. Q. Mok,, L. MacCallum, et al. 1991. Do maternal factors influence the risk of HIV?, abstr. W.C. 3237. In Proceedings of the VII International Conference on AIDS.
31. Hutto, C.,, W. P. Parks,, S. Lai,, M. C. Mastrucci,, C. Mitchell,, J. Munoz,, E. Tropida,, I. M. Master,, and G. B. Scott. 1991. A hospital-based prospective study of peri-natal infection with human immunodeficiency virus type 1. J. Pediatr. 118:347353.
32. Irwin, K.,, N. Olivo,, C. A. Schable,, J. T. Weber,, R. Janssen,, and J. Ernst. 1996. Performance characteristics of a rapid HIV antibody assay in a hospital with a high prevalence of HIV infection. Ann. Intern. Med. 125:471475.
33. John, G. C.,, R. W. Nduati,, D. Mbori-Ngacha,, J. Overbaugh,, M. Welch,, B. A. Rich-ardson,, J. Ndinya-Achola,, J. Bwayo,, J. Krieger,, F. Onyango,, and J. Kreiss. 1997. Genital shedding of human immunodeficiency virus type 1 DNA during preg-nancy: association with immunosuppression, abnormal cervical or vaginal dis-charge, and severe vitamin A deficiency. J. Infect. Dis. 175:5762.
34. Kind, C.,, B. Brändle,, C.A. Wyler,, A. Calame,, C. Rudin,, U.B. Schaad,, J. Schüpbach,, H. P. Senn,, L. Perrin,, and L. Matter. 1992. Epidemiology of vertically transmitted HIV 1 infection in Switzerland: results of a nationwide prospective study. Eur. J. Pediatr. 151:442448.
35. Kreiss, J.,, P. Datta,, D. Willerford, et al. 1991. Vertical transmission of HIV in Nai-robi: correlation with maternal viral burden, abstr. W.C. 3062. In Proceedings of the VII International Conference on AIDS.
36. Lallemant, M.,, S. Le Coeur,, L. Samba,, D. Cheynier,, P. M’Pelé,, S. Nzingoula,, and M. Essex. 1994a. Mother-child transmission of HIV-1 and infant survival in Braz-zaville, Congo. AIDS 3:643646.
37. Lallemant, M.,, A. Baillou,, S. Lallemant-Le Coeur,, S. Nzingoula,, M. Mampaka,, P. M’Pelé,, F. Barin,, and M. Essex. 1994b. Maternal antibody response at delivery and perinatal transmission of human immunodeficiency virus type-1 in African women. Lancet 343:10011005.
38. Landesman, S.,, and D. Burns. 1996. Quantifying HIV. JAMA 275:640641.
39. Landesman, S.,, H. Minkoff,, S. Holman,, S. McCalla,, and O. Sijin. 1987. Serosurvey of human immunodeficiency virus infection in parturients. JAMA 258:2701.
40. Landesman, S.,, B. Weiblem,, H. Mendez,, A. Willoughby,, J. J. Goedert,, A. Rub-enstein,, H. Minkoff,, G. Moroso,, and R. Hoff. 1991. Clinical utility of HIV-IgA assay in the early diagnosis of perinatal HIV infection. JAMA 266:34433446.
41. Landesman, S. H.,, L. A. Kalish,, D. N. Burns,, H. Minkoff,, H. E. Fox,, C. Zorrilla,, P. Garcia,, M. G. Fowler,, L. Mofenson,, and R. Tuomala. 1996. The relationship of obstetrical factors to the mother-to-child transmission of HIV-1. N. Engl. J. Med. 334:16171623.
42. Lapointe, N.,, J. Michaud,, D. Pekovic,, J. P. Chausseau,, and J. P. Dupuy. 1985. Trans-placental transmission of HTLV-III virus. N. Engl. J. Med. 312:1325.
43. Lepage, P.,, P. Van de Perre,, M. Caraël,, F. Nsengumuremyi,, J. Nkurunziza,, J. P. Butzler,, and S. Sprecher. 1987. Postnatal transmission of HIV mother to child. Lancet ii:400.
44. Lepage, P.,, F. Dabis,, D. G. Hitimana,, P. Msellati,, C. Van Goethem,, A. M. Stevens,, F. Nsengumuremyi,, A. Bazubagira,, A. Serufilira,, and A. De Clercq. 1991. Peri-natal transmission of HIV-1: lack of impact of maternal HIV infection on charac-teristics of live births and neonatal mortality in Kigali, Rwanda. AIDS 5:295300.
45. Lindgren, S.,, B. Anzen,, A. Bohlin,, and K. Lidman. 1991. HIV and childbearing: clinical outcome and aspects of mother-to-infant transmission. AIDS 5:11111116.
46. Mandelbrot, L.,, M. J. Mayaux,, A. Bongain,, A. Berrebi,, Y. Moudoub-Jeanpetit,, J. L. Bénifla,, N. Ciraru-Vigneron,, J. Le Chenadec,, S. Blanche,, and J. F. Delfraissy. 1996. Obstetric factors and mother-to-child transmission of human immunodeficiency virus type 1: the French perinatal cohorts. Am. J. Obstet. Gynecol. 175:661667.
47. Mayers, M. M.,, K. Davenny,, E. E. Schoenbaum,, A. R. Feingold,, P. A. Selwyn,, V. Robertson,, C. Y. Ou,, M. F. Rogers,, and M. Naccarato. 1991. A prospective study of infants of human immunodeficiency virus seropositive and seronegative women with a history of intravenous drug-using partners in the Bronx, New York City. Pediatrics 88:12481256.
48. Miles, S. A.,, E. Balden,, L. Magpantay,, L. Wei,, A. Leiblein,, D. Hofheinz,, G. Toedter,, E. R. Steihm,, and Y. Bryson. 1993. Rapid serologic testing with immune-complex-dissociated HIV p24 antigen for early detection of HIV infection in neonates. N. Engl. J. Med. 328:297302.
49. Minkoff, H.,, and M. Augenbraun. 1997. Antiretroviral therapy of the pregnant women. Am. J. Obstet. Gynecol. 176:478489.
50. Minkoff, H.,, and M. Mofenson. 1994. The role of obstetrical interventions in the prevention of pediatric human immunodeficiency virus infection. Am. J. Obstet. Gynecol. 171:11671175.
51. Minkoff, H.,, and J. Moreno. 1990. Drug prophylaxis for human immunodeficiency virus infected pregnant women: ethical considerations. Am. J. Obstet. Gynecol. 163: 11111113.
52. Minkoff, H. L.,, C. Henderson,, H. Mendez,, M. H. Gail,, S. Holman,, A. Willoughby,, J. J. Goedett,, A. Rubinstein,, P. Stratton,, and J. H. Walsh. 1990. Pregnancy out-comes among women infected with HIV and matched controls. Am. J. Obstet. Gynecol. 163:15981603.
53. Minkoff, H.,, J. Moreno,, and K. Powderly. 1992. Fetal protection and women’s ac-cess to clinical trials. Am. J. Women’s Health 1:137140.
54. Minkoff, H.,, D. Burns,, S. Landesman,, J. Youchah,, J. J. Goedert,, R. P. Nugent,, L. R. Muenz,, and A. D. Willoughby. 1995. The relationship of the duration of rup-tured membranes to vertical transmission of HIV. Am. J. Obstet. Gynecol. 173:585589.
55. Miotti, P.,, R. Yolken,, J. Canner, et al. 1993. Mucosal factors and transmission of HIV from mother to infant, abstr. 673. In Proceedings of the First National Conference on Human and Other Related Retroviruses.
56. Mofenson, L. M. 1997. Mother-child HIV-1 transmission: timing and determinants. Obstet. Gynecol. Clin. North Am. 24:759784.
57. Mofenson, L. M.,, E. R. Stiehm,, J. Lambert, et al. 1997. Efficacy of zidovudine (ZDV) in reducing perinatal HIV-1 transmission in HIV-1 infected women with advanced disease, abstr. I-117. In Program and Abstracts of the 37th Interscience Conference on Antimicrobial Agents and Chemotherapy. American Society for Microbiology, Wash-ington, D.C.
58. Nielsen, K.,, P. Boyer,, M. Dillion,, D. Wafer,, L. S. Wei,, E. Garratty,, R. E. Dickover,, and Y. J. Bryson. 1996. Presence of human immunodeficiency virus (HIV) type 1 and HIV-1-specific antibodies in cervicovaginal secretions of infected mothers and in the gastric aspirates of their infants. J. Infect. Dis. 173:10011004.
59. Quinn, T. C.,, R. L. Kline,, N. Halsey,, N. Hutton,, A. Ruff,, A. Butz,, R. Boulos,, and J. Modlin. 1991. Early diagnosis of perinatal HIV infection by detection of viral specific IgA antibodies. JAMA 266:34393442.
60. Rasheed, S.,, Z. Li,, D. Xu,, and A. Kovacs. 1996. Presence of cell-free human immunodeficiency virus in cervicovaginal secretions is independent of viral load in the blood of human immunodeficiency virus-infected women. Am. J. Obstet. Gy-necol. 175:122130.
61. Rossi, P.,, V. Moschese,, P. A. Broliden,, C. Fundaró,, I. Quinti,, A. Plebani,, C. Gia-quinto,, P. A. Tovo,, K. Ljunggren,, and J. Rosen. 1989. Presence of maternal antibodies to human immunodeficiency virus 1 envelope glycoprotein gp120 epitopes correlates with the noninfective status of children born to seropositive mothers. Proc. Natl. Acad. Sci. USA 86:80558058.
62. Ryder, R. W.,, W. Nsa,, S. E. Hassig,, F. Behets,, M. Rayfield,, B. Ekungola,, A. M. Nelson,, U. Mulenda,, H. Francis,, and K. Mwandagalirwa. 1989. Perinatal trans-mission of the human immunodeficiency virus type 1 to infants of seropositive women in Zaire. N. Engl. J. Med. 320:16371642.
63. Shearer, W. T.,, T. C. Quinn,, P. LaRussa,, J. F. Lew,, L. Mofenson,, S. Almy,, K. Rich,, E. Handelsman,, C. Diaz,, M. Pagano,, V. Smeriglio,, and L. A. Kalish. 1997. Viral load and disease progression in infants infected with human immunodeficiency virus type 1. N. Engl. J. Med. 336:13371342.
64. Soeiro, R.,, W. F. Rashburn,, A. Rubenstein,, and W. D. Lyman. 1991. The incidence of human fetal HIV-1 infection as determined by the presence of HIV-1 DNA in abortus tissues, abstr. W.C. 3250. In Proceedings of the VII International Conference on AIDS.
65. Sperling, R. S.,, P. Stratton,, J. O’Sullivan,, B. Boyer,, D. H. Watts,, J. S. Lambert,, H. Hammill,, E. Livingston,, D. J. Gloeb,, H. L. Minkoff,, and H. Fox. 1992. A survey of Zidovudine use in pregnant women with immunodeficiency virus infection. N. Engl. J. Med. 326:857861.
66. Sperling, R. S.,, D. E. Shapiro,, R. W. Coombs,, J. A. Todd,, S. A. Herman,, G. D. McSherry,, M. J. O’Sullivan,, R. B. Van Dyke,, E. Jimenez,, C. Rouzioux,, P. M. Flynn,, and J. L. Sullivan. 1996. Maternal viral load, zidovudine treatment and the risk of transmission of human immunodeficiency virus type 1 from mother to infant. N. Engl. J. Med. 335:16211629.
67. St. Louis, M. E.,, M. Kamenga,, C. Brown,, A. M. Nelson,, T. Manzila,, V. Batter,, F. Behets,, U. Kabagabo,, R. W. Ryder,, and M. Oxtoby. 1993. Risk for perinatal HIV-1 transmission according to maternal immunologic, virologic and placental fac-tors. JAMA 269:28532859.
68. Temmerman, M.,, E. N. Chomba,, J. Ndinya-Achola,, F. A. Plummer,, M. Coppens,, and P. Piot. 1994. Maternal HIV-1 infection and pregnancy outcome. Obstet. Gy-necol. 83:495501.
69. Tibaldi, C.,, E. Palomba,, N. Ziarati, et al. 1991. Maternal factors influencing vertical HIV transmission, abstr. W. C. 3277. In Proceedings of the VII International Conference on AIDS.
70. Van de Perre, P.,, A. Simonon,, P. Msellati,, D. G. Hitimana,, D. Vaira,, A. Baxubagira,, C. Van Goethem,, A. M. Stevens,, E. Karita,, and D. Sondag-Thull. 1991. Postnatal transmission of HIV type 1 from mother to infant. N. Engl. J. Med. 325:593.
71. Villari, P.,, C. Spino,, T. C. Chalmer,, J. Lau,, and H. S. Sacks. 1993. Cesarean section to reduce prenatal transmission of human immunodeficiency virus: a meta-analysis online. J. Curr. Clin. Trials (document 74).
72. Viscarello, R.,, M. T. Cullen,, N. J. DeGennaro,, and J. C. Hobbins. 1992. Fetal blood sampling in human immunodeficiency-seropositive women before elective mid-trimester termination of pregnancy. Am. J. Obstet. Gynecol. 167:10751079.
73. Whaley, K. J.,, L. Zeitlin,, R. A. Barratt,, T. E. Hoen,, and R. A. Cone. 1994. Passive immunization of the vagina protects mice against vaginal transmission of genital herpes infections. J. Infect. Dis. 169:647649.
74. Ziegler, J. B.,, D. A. Cooper,, R. O. Johnson,, and J. Gold. 1985. Postnatal transmission of AIDS-associated retrovirus from mother to infant. Lancet 1:896.
75. Ziegler, J. B.,, G. J. Stewart,, R. Penney, et al. 1988. Breast-feeding and transmission of HIV from mother to infant, abstr. 5100. In Proceedings of the Fourth Annual International AIDS Conference.

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