Background: Randomized controlled trials have demonstrated that zidovudine therapy decreases the mother-to-infant transmission of human immunodeficiency virus 1 (HIV-1). Data from large observational studies may provide further important findings on the effectiveness at the population level of combined treatments in decreasing transmission. Objective: To evaluate time trends in prophylactic interventions and the determinants of transmission both before and after the introduction of antiretroviral prophylaxis, and in treated and untreated mother-infant pairs after 1995. Design and Setting: Analysis of prospective data on 3770 children born to HIV-1-infected women between 1985 and 1999 and reported to the Italian Register for HIV Infection in Children. Main Outcome Measures: Logistic regression random effects models were used to estimate crude and adjusted odds ratios for several factors potentially influencing vertical transmission for 2periods-1985 through 1995 (January 1, 1985, through December 31,1995) and 1996 through 1999 (January 1, 1996, through December 31, 1999), and between treated and untreated children after 1995. Results: The transmission rate was 15.5% in the 19851995 period and 5.8% in the 1996-1999 period. By 1999, prophylactic interventions had greatly increased. Antiretroviral treatment (ART) usage was 89.9%, (55.1% combination ART) and the elective cesarean delivery rate was 81.3%. In multivariate analysis, only elective cesarean delivery was associated with a lower risk of mother-to-infant transmission before 1995. After 1995, nonbreastfeeding and receipt of ART were protective whereas elective cesarean delivery was not significantly protective in multivariate analysis. Transmission risk was reduced by 76% with an incomplete zidovudine regimen, 88% with a complete regimen, and 93% when the mother received combination ART. In the 1996-1999 period, the transmission rate for nonbreastfeeding mother-infant pairs was 8.6% with elective cesarean delivery, 4.4% with any ART, and 2.4% with these interventions combined.
|Autori interni:||CONSOLINI, RITA|
|Autori:||The Italian Register for Human Immunodeficiency Virus Infection in Children. De Martino; M; Galli; L; Tovo; PA; Gabiano; C Pezzotti; P; Wagner; TM; Rezza; Partecipants: G Osimani; De Mattia D; Di Bari C; Ruggeri; M; Baldi; F; Ciccia; M; Lanari; M; M; Masi; M; Venturi; V; Battisti; L; Duse; M; Chiriaco; PG; Cavallini; R; Dessi; C; Pintor; C; Anastasio; E; Sabatino; G; Sticca; M; Pomero; G; Bezzi; T; Chiappini; E; De Luca; M; Gervaso; P; Cecchi; MT; Bassetti; D; Gotta; C; Rosso; R; Timitilli; A; Tondo; U; Mussini; P; Bricalli; D; Bucceri; A; Ferraris; G; Giovannini; M; Mosca; F; Lipreri; R; Guarino; A; Plebani; A; Riva; E; Riva; S; Vigano; A; Zuccotti; GV; Cellini; M; Buffolano; W; Guarino; A : Tarallo; L; D'Elia; R; Giaquinto; C; Rampon; O; Dalle Nogare; ER; Romano; A; Caselli; D; Maccabruni; A; Consolini R; et al|
|Titolo:||Determinants of mother-to-infant human immunodeficiency virus 1 transmission before and after the introduction of zidovudine prophylaxis|
|Anno del prodotto:||2002|
|Appare nelle tipologie:||1.1 Articolo in rivista|