Combined evaluation of sexually transmitted infections in HIV-infected pregnant women and infant HIV transmission
Morgado, Mariza G.
Watts, D. Heather
Mofenson, Lynne M.
Veloso, Valdilea G.
Pilotto, Jose Henrique
Mussi-Pinhata, Marisa M.
Machado, Daisy Maria [UNIFESP]
Bryson, Yvonne J.
Klausner, Jeffrey D.
Bristow, Claire C.
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Background Sexually transmitted infections (STIs) including Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Treponema pallidum (TP), and cytomegalovirus (CMV) may lead to adverse pregnancy and infant outcomes. The role of combined maternal STIs in HIV mother-to-child transmission (MTCT) was evaluated in mother-infant pairs from NICHD HPTN 040. Methodology Urine samples from HIV-infected pregnant women during labor were tested by polymerase chain reaction (PCR) for CT, NG, and CMV. Infant HIV infection was determined by serial HIV DNA PCR testing. Maternal syphilis was tested by VDRL and confirmatory treponemal antibodies. Results A total of 899 mother-infant pairs were evaluated. Over 30% had at least one of the following infections (TP, CT, NG, and/or CMV) detected at the time of delivery. High rates of TP (8.7%), CT (17.8%), NG (4%), and CMV (6.3%) were observed. HIV MTCT was 9.1% (n = 82 infants). HIV MTCT was 12.5%, 10.3%, 11.1%, and 26.3% among infants born to women with CT, TP, NG or CMV respectively. Forty-two percent of HIV-infected infants were born to women with at least one of these 4 infections. Women with these infections were nearly twice as likely to have an HIV-infected infant (aOR 1.9, 95% CI 1.1-3.0), particularly those with 2 STIs (aOR 3.4, 95% CI 1.5-7.7). Individually, maternal CMV (aOR 4.4 1.5-13.0) and infant congenital CMV (OR 4.1, 95% CI 2.2-7.8) but not other STIs (TP, CT, or NG) were associated with an increased risk of HIV MTCT. Conclusion HIV-infected pregnant women identified during labor are at high risk for STIs. Co-infection with STIs including CMV nearly doubles HIV MTCT risk. CMV infection appears to confer the largest risk of HIV MTCT.
CitationPlos One. San Francisco, v. 13, n. 1, p. -, 2018.
(Brazilian AIDS Prevention Trials International Network), NIAID/ NIH
National Institute of Allergy and Infectious Diseases (NIAID)
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
National Institute of Mental Health (NIMH)
Boehringer Ingelheim Pharmaceuticals Inc. (BIPI)
GlaxoSmithKline, on behalf of ViiV Healthcare
Cepheid for the testing of CT
NG in a prior HPTN
UCLA Children's Discovery and Innovation Institute (CDI) through the Harry Winston Fellowship Award
UCLA AIDS Institute
UCLA Center for AIDS Research (CFAR) NIH/ NIAID
UCLA Pediatric AIDS Coalition, and Westat
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