1. Breastfeeding, genetic, obstetric and other risk factors associated with mother-to-child transmission of HIV-1 in Sao Paulo State, Brazil. Sao Paulo Collaborative Study for Vertical Transmission of HIV-1.
- Author
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Tess BH, Rodrigues LC, Newell ML, Dunn DT, and Lago TD
- Subjects
- Alcohol Drinking, Amniocentesis, Brazil epidemiology, Cesarean Section, Disease Susceptibility, Female, Gestational Age, HIV Infections prevention & control, Humans, Infant, Infant, Newborn, Male, Maternal Age, Multivariate Analysis, Pregnancy, Pregnancy Complications, Infectious, Racial Groups, Rh-Hr Blood-Group System, Risk Factors, Sexual Behavior, Breast Feeding, HIV Infections transmission, HIV-1, Infectious Disease Transmission, Vertical
- Abstract
Objectives: To evaluate the effect of maternal, obstetric, neonatal and post-natal factors on the risk of vertical transmission of HIV-1., Design: Multicentre retrospective cohort study., Setting: Obstetric and paediatric clinics in four cities in Sao Paulo State, Brazil., Main Outcome: Child's HIV-1 infection status., Methods: Data were collected by standardized record abstraction and interview on 553 children born to women identified as HIV-1-infected before or at delivery. Paediatric infection was determined by immunoglobulin G anti-HIV-1 tests at age 18 months or by AIDS diagnosis at any age. Multivariate logistic regression was used to assess the effect of potential risk factors on vertical transmission of HIV-1., Results: HIV-1 infection status was determined for 434 children (follow-up rate of 78%); 69 were classified as HIV-1-infected [transmission risk, 16%; 95% confidence interval (CI), 13-20%]. In multivariate analysis, advanced maternal HIV-1 disease [odds ratio (OR), 4.5; 95% CI, 2.1-9.5], ever breastfed (OR, 2.2; 95% CI, 1.2-4.2), child's negative Rhesus blood group (OR, 2.5; 95% CI, 1.2-5.5), third trimester amniocentesis (OR, 4.1; 95% CI, 1.2-13.5) and black racial group (OR, 0.3; 95% CI, 0.1-0.9) were independently and significantly associated with mother-to-child transmission of HIV-1. Transmission was increased marginally with prematurity, more than 10 lifetime sexual partners and prolonged duration of membrane rupture. No association was found between child's HIV-1 infection and mode of delivery or serological evidence of syphilis during pregnancy., Conclusion: These findings support the importance of severity of maternal HIV-1 disease in the risk of vertical transmission of HIV-1, indicate measures to reduce transmission by avoiding amniocentesis and breastfeeding and suggest that race and Rhesus blood type may be markers for genetic susceptibility to infection.
- Published
- 1998
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