57 total pregnancies were evaluated in 51 HIV-infected women who had delivered between 1/93-10/96. Prenatal care, HIV disease state, intrapartum procedures, delivery method, complications, and antiretroviral use were assessed through an interview and chart review. HIV infection status of infants was based on 6 month follow-up. Participants had a mean age of 23.1 years (range 15-37), a mean CD4+ count of 419 (range 39-1331), and were predominantly African American (81.8%). The vertical transmission (VT) rate among this cohort as a whole was 22.8%. The VT rate was higher in 1993-94 than in 1995-96 (11/25, 44.0% vs. 2/30, 6.6%, P=.003). Perinatal ZDV was given during 40 pregnancies (70.1%), and use was associated with decreased VT (6/40, 15% vs. 7/17, 41.2%, P=.04). In 1995-96, the number of women and children who received any perinatal zidovudine (ZDV) was significantly higher than in subsequent years (30/32 vs. 10/25, P=.00004). The VT rate was significantly higher among women with <290 CD4+ cells/uL (lowest CD4+ quartile) vs. CD4+ counts >290 at delivery (5/11, 45.5% vs. 2/33, 6.0%, P=.007). No difference in VT was seen by CD8+ count, CD4+%, or CD8+% quartiles. Women who transmitted HIV to their newboms were somewhat older (mean age 25.5 vs. 22.4, P=.055), and began prenatal care later in their pregnancies (mean gestational age of first prenatal care visit 21.1 vs. 15.0 weeks, P=.02). The presence of HIV-related illness, history of STDs, drug use, method of delivery, intrapartum procedures, and delivery complications were not predictive of VT. Implementation of ACTG Protocol 076 in St. Louis, Missouri, has been successful in reducing VT of HIV. Aggressive efforts are required to insure HIV testing and early prenatal care in HIV+ women.

Original languageEnglish
Number of pages1
JournalClinical Infectious Diseases
Issue number2
StatePublished - Dec 1 1997


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