Mother-to-Child Transmission of HIV Infection in the Era of Highly Active Antiretroviral Therapy European Collaborative Studya

Background. Very low rates of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) are achievable with use of highly active antiretroviral therapy (HAART). We examine risk factors for MTCT in the HAART era and describe infants who were vertically infected, despite exposure to prophylactic MTCT interventions. Methods. Of the 4525 mother-child pairs in this prospective cohort study, 1983 were enrolled during the period of January 1997 through May 2004. Factors examined included use of antiretroviral therapy during preg-nancy, maternal CD4 cell count and HIV RNA level, mode of delivery, and gestational age in logistic regression analysis. Results. Receipt of antenatal antiretroviral therapy increased from 5 % at the start of the HAART era to 92% in 2001–2003. The overall MTCT rate in this period was 2.87 % (95 % confidence interval [CI], 2.11%–3.81%), but it was 0.99 % (95 % CI, 0.32%–2.30%) during 2001–2003. In logistic regression analysis that included 885 mother-child pairs, MTCT risk was associated with high maternal viral load (adjusted odds ratio [AOR], 12.1;) and elective Caesarean section (AOR, 0.33;). Detection of maternal HIV RNA was significantlyPp.003 Pp.04 associated with antenatal use of antiretroviral therapy, CD4 cell count, and mode of delivery. Among 560 women with undetectable HIV RNA levels, elective Caesarean section was associated with a 90 % reduction in MTCT risk (odds ratio, 0.10; 95 % CI, 0.03–0.33), compared with vaginal delivery or emergency Caesarean section