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1. Respective roles of migration and social deprivation for virological non-suppression in HIV-infected adults on antiretroviral therapy in France.

Author

Mariem Raho-Moussa, Marguerite Guiguet, Céline Michaud, Patricia Honoré, Christia Palacios, François Boué, Mohammed Azghay, Imad Kansau, Véronique Chambrin, Tania Kandel, Marion Favier, Elsa Miekoutima, Naomi Sayre, Carole Pignon, Michka Shoai, Olivier Bouchaud, and Sophie Abgrall

Subjects
Medicine, Science
Abstract

Barriers to achieve sustained HIV virological suppression on antiretroviral therapy (ART) jeopardize the success of the 90:90:90 UNAIDS initiative which aims to end the HIV/AIDS epidemic. In France, where access to ART is free and universally available, we analyze the way in which social determinants of health (i.e. cultural, environmental) and economic factors might influence virological outcomes. A cross-sectional study was performed in two hospitals located in Paris area. All consecutive people living with HIV (PLHIV) on ART for at least 6 months attending the outpatient clinics between 01/05/2013 and 31/10/2014 answered an individual score of deprivation, EPICES, retrieving information on health insurance status, economic status, family support and leisure activity. This score varies from 0 to 100 with deprivation state defined above 30.17. Factors associated with HIV viral load >50 copies/ml were assessed by logistic regression modeling with a backward stepwise selection to select the final multivariable model. Sensitivity analyses were performed using two other thresholds for virological non-suppression (100 or 200 copies/ml). Overall, 475 PLHIV were included (53% male, median age 47 years, 66% not born in France mainly in a sub-Saharan African country). Half of French natives and 85% of migrants were classified as deprived. Median duration on ART was 9.7 years with virological suppression in 95.2% of non-deprived participants and in 83.5% of deprived ones (p = 0.001). The final multivariable model retained ART tiredness, younger age, a previous AIDS event and social deprivation (adjusted Odds Ratio, 2.9; 95%CI, 1.2-7.0) as determinants of virological non-suppression but not migration in itself. When using separate components of EPICES score, reporting economic difficulties and non-homeownership were associated with virological non-suppression. In addition to interventions focusing on cultural aspects of migration, social interventions are needed to help people with social vulnerability to obtain sustained responses on ART.

Published
2019
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2. Relapsing generalized bullous fixed drug eruption: A severe and avoidable cutaneous drug reaction. Three case reports

Author

Amandine Weill, Camille Hua, Nicolas Ortonne, Olivier Chosidow, Pierre Wolkenstein, Haudrey Assier, Clément Braesch, Laure Thomas, Lionel Nakad, Charlotte Bernigaud, Véronique Chambrin, Bénédicte Lebrun-Vignes, Saskia Ingen-Housz-Oro, and O. Gaudin

Subjects
Medication error, medicine.medical_specialty, business.industry, medicine, Pharmacology (medical), Drug reaction, medicine.disease, business, Dermatology, Drug eruption
Published
2022

3. Respective roles of migration and social deprivation for virological non-suppression in HIV-infected adults on antiretroviral therapy in France

Author

Tania Kandel, Imad Kansau, Carole Pignon, Patricia Honoré, François Boué, Céline Michaud, Marion Favier, Sophie Abgrall, Mariem Raho-Moussa, Olivier Bouchaud, Naomi L. Sayre, Véronique Chambrin, Elsa Miekoutima, Marguerite Guiguet, Christia Palacios, Michka Shoai, Mohammed Azghay, Hôpital Antoine Béclère, Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Université (SU), Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris 13 (UP13), Centre de recherche en épidémiologie et santé des populations (CESP), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)

Subjects
Male, RNA viruses, 0301 basic medicine, Sustained Virologic Response, Social Determinants of Health, Economics, Cross-sectional study, Social Sciences, HIV Infections, Pathology and Laboratory Medicine, Toxicology, Geographical locations, 0302 clinical medicine, Immunodeficiency Viruses, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Medicine and Health Sciences, Outpatient clinic, Medicine, Public and Occupational Health, 030212 general & internal medicine, 10. No inequality, Transients and Migrants, Human Capital, Multidisciplinary, Middle Aged, Viral Load, Vaccination and Immunization, Socioeconomic Aspects of Health, Europe, Cultural deprivation, Social deprivation, Medical Microbiology, Viral Pathogens, Viruses, Female, France, Pathogens, Economics of Migration, Viral load, Research Article, Adult, Paris, Anti-HIV Agents, Science, Immunology, Psychosocial Deprivation, Antiretroviral Therapy, Microbiology, 03 medical and health sciences, Antiviral Therapy, Acquired immunodeficiency syndrome (AIDS), Virology, Retroviruses, Humans, European Union, Social determinants of health, Microbial Pathogens, Toxicity, business.industry, Lentivirus, Organisms, HIV, Biology and Life Sciences, Odds ratio, medicine.disease, 030112 virology, Health Care, Cross-Sectional Studies, Socioeconomic Factors, Cultural Deprivation, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Preventive Medicine, People and places, business, Finance, Viral Transmission and Infection, Demography
Abstract

International audience; Barriers to achieve sustained HIV virological suppression on antiretroviral therapy (ART) jeopardize the success of the 90:90:90 UNAIDS initiative which aims to end the HIV/AIDS epidemic. In France, where access to ART is free and universally available, we analyze the way in which social determinants of health (i.e. cultural, environmental) and economic factors might influence virological outcomes. A cross-sectional study was performed in two hospitals located in Paris area. All consecutive people living with HIV (PLHIV) on ART for at least 6 months attending the outpatient clinics between 01/05/2013 and 31/10/2014 answered an individual score of deprivation, EPICES, retrieving information on health insurance status, economic status, family support and leisure activity. This score varies from 0 to 100 with deprivation state defined above 30.17. Factors associated with HIV viral load >50 copies/ml were assessed by logistic regression modeling with a backward stepwise selection to select the final multivariable model. Sensitivity analyses were performed using two other thresholds for virological non-suppression (100 or 200 copies/ml). Overall, 475 PLHIV were included (53% male, median age 47 years, 66% not born in France mainly in a sub-Saharan African country). Half of French natives and 85% of migrants were classified as deprived. Median duration on ART was 9.7 years with virological suppression in 95.2% of non-deprived participants and in 83.5% of deprived ones (p = 0.001). The final multivariable model retained ART tiredness, younger age, a previous AIDS event and social deprivation (adjusted Odds Ratio, 2.9; 95%CI, 1.2-7.0) as determinants of virological non-suppression but not migration in itself. When using separate components of EPICES score, reporting economic difficulties and non-homeownership were associated with virological non-suppression. In addition to interventions focusing on cultural aspects of migration, social interventions are needed to help people with social vulnerability to obtain sustained responses on ART.

Published
2019

4. Is Intrapartum Intravenous Zidovudine for Prevention of Mother-to-Child HIV-1 Transmission Still Useful in the Combination Antiretroviral Therapy Era?

Author

Nelly Briand, Josiane Warszawski, Laurent Mandelbrot, Catherine Dollfus, Emmanuelle Pannier, Ludovic Cravello, Rose Nguyen, Isabelle Matheron, Norbert Winer, Roland Tubiana, Christine Rouzioux, Albert Faye, Stéphane Blanche, Françoise Meier, Dominique Duro, Marine Joras, Emmanuel Mortier, Catherine Crenn-Hebert, Corinne Floch-Tudal, Fabienne Mazy, Mariam Bensalah, Agnès Villemant-Uludag, Agnès Lefort, Virginie Zarrouk, Pierre-François Ceccaldi, Gisèle Philip, Gilles Hittinger, Martine Malet, Bruno Bachelard, Marie Medus, Joëlle Dendale-Nguyen, Jean-Pierre Brossier, Olivier Aubry, Jean-Luc Esnault, Sophie Leautez, Philippe Perré, Isabelle Suaud, Sandrine-Anne Martha, Mahfoud Rouha, Pascale Perfezou, Gilles Blondin, Charles Bellot, Séverine Ansart, Philippe Le Moine, Karine Bages-Jaffuel, Jean-Charles Duthé, Michel Garré, Sylvain Jaffuel, Corinne Daniel, Christian Calvez, Claude Beuscart, Emmanuelle Boutaric, Jennifer Rohan, Sylvie Lemoal, Linda Lassel, Ghislaine Cotten, Christelle Dupré, Esther Beauville, Cédric Arvieux, Anabèle Dos Santos, Corinne Cudeville, Yves Poinsignon, Virginie Mouton-Rioux, Gaétane Mousset, Anne Grellier, Philippe Moreau, Philippe Tillaut, Odile Luycx-Vaillant, Philippe de Morel, Marie-Françoise Le Coz, Isabelle Belzic, Mathilde Niault, Anne Vandenbergh, Cécile Janssen, Susanne Braig, Virginie Vitrat, Jacques Gaillat, Gaëlle Clavere, Jean-Pierre Bru, Blandine Peyret, Catherine Mullard, Marie Echard, Philippe Talon, Marion Dehlinger, Cécile Winter, Brigitte Heller-Roussin, Odile Launay, Maria Fouchet, Ghislaine Firtion, Isabelle Goupil, Nora Boudjoudi, Agnès Bourgeois-Moine, Marylène Bodard, Valérie Vivier, Mandovi Rajguru, Virginie Huri, Elie Azria, Sophie Matheron, Neila Elaoun, Philippe Faucher, Valérie Garrait, Christiane Komme, Isabelle Hau, Laurent Richier, Claudine Touboul, Valérie Thoirain, Laurent Cotte, Olivier Tariel, Joseph Koffi, Jean-Marc Labaune, Corinne Brochier, Denis Roux, Christophe Elleau, Camille Runel, Henri Bataille, Marie-Thérèse Sow, Ketty Samar, Blandine Muanza, Marc Duval, Clarisse Kingue-Ekollo, Bénédicte Carpentier, Isabelle Ronda, Jean-Marc Chamouilli, Natacha Entz-Werle, Hervé Seaume, Sarah Ducrocq, Philippe Bailly-Salin, Yvon Lemercier, Joëlle Tricoire, Alain Berrebi, Michèle Antras, Evelyne Armand, Claudine Cayla, François Bonnal, Catherine Chabanier, Anne Chacé, Sophie Couderc, Anne Boutemy, Marie-Christelle Dallot, Alain Al-Issa, Corinne Routier, Ahmed Zakaria, Véronique Favret, Juliette Gerbe, Elisabeth Questiaux, MariaLuisa Partisani, David Rey, Christine Cheneau, Christine Allisy, Dominique Brault, François Hervé, Marie-Gisèle Lebrette, Lise Selleret, Dieudonné Ekoukou, Pascal Bolot, Marie-Aude Khuong-Josses, Marie-Christine Allemon, Nelly Ghibaudo, Pierre Frange, Florence Veber, Delphine Lemercier, Marie-Christine Mourey, Gilles Blasquez, Michèle Granier, Houda Touahri, Alain Devidas, Israël Nisand, Michèle Weil, Christophe Vayssière, Jean-Luc Berger, Martine Munzer, Olivier Graesslin, Anne-Florence Naime-Alix, Frédérique Quetin, Anne Laubies, Manuela Bonmarchand, Jennifer Sommer, Patricia Bourse, Anne Coursol, Michel Youssef, Juliette Laurent, Mariem Raho, Véronique Chambrin, Philippe Labrune, Laure Clech, Alexandra Benachi, Bertrand Le Lorier, Isolde Pauly-Ravelly, Claude Allouche, Ama Johnson, Laurence Benoist, Catherine Delannoy, Eric Lachassine, Stéphanie Bolie, Joël Gaudelus, Vincent Jeantils, Amelie Benabara, Leïla Karaoui, Véronique Lefèvre, André Bongain, Eliane Galiba, Anne Deville, Fabrice Monpoux, Jacques Durant, Christian Aufrant, Jean Furioli, Jean-Louis Salomon, Françoise Granier, Antoine Doumet, Youssef Douadi, Jean Gondry, Jean-Luc Schmit, Brigitte Pautard, Marc Gamerre, Isabelle Thuret, Laurence Neimann, Claire Hubert, Bruno Carbonne, Geneviève Vaudre, Marie-Dominique Tabone, Didier Pinquier, Gaëlle Pinto Cardoso, Brigitte Clavier, Françoise Borsa-Lebas, Agathe De Lauzanne, Constance Borie, Sandrine Leveillé, Erianna Bellaton, Dominique Garion, Martine Levine, Claire Colmant, Cécile Goujard, Marc Tardieu, Florent Fuchs, Ikram Jrad, Delphine Peretti, Katia Bourdic, Corinne Fourcade, Catherine Chirouze, Jean-Marie Estavoyer, Robert Maillet, Véronique Reliquet, Cécile Brunet, Isabelle Reynaud, Claire Briandet, Jacques Brouard, Gaël Beucher, Pascale Goubin, Cécile Lanty, Eric Froguel, Béatrice Gourdel, Arnaud Chalvon Demersay, Gilbert Algava, Véronique Hentgen, Fabienne Messaoudi, Pascale Nau, Jean-Marc Besnier, Jérôme Potin, Nadine Taché, Yves Bertrand, Kamila Kebaïli, Véronique Ronat, Anne Fresard, Kareen Billiemaz, Ramona Abrudan, Alain Fournié, Jean-Marie Chennebault, Philippe Arsac, Nicole Ciraru-Vigneron, Geneviève Mouchnino, Dominique Ayral, Nelly Guigue, Muriel Lalande, Paul Benos, Christiane De Gennes, Sonia Chanzy, Valérie Isart, François Cazassus, Véronique Walter, François Bissuel, Yamina Hammou, Sophie d'Angelo, Faïza Ajana, Françoise Mazingue, Raymond Mezin, Yves Hatchuel, André Cabié, and Narcisse Elenga

Subjects
Adult, Male, Microbiology (medical), medicine.medical_specialty, Anti-HIV Agents, HIV Infections, Zidovudine, Pregnancy, Risk Factors, immune system diseases, medicine, Humans, Prospective Studies, Pregnancy Complications, Infectious, Antibiotic prophylaxis, Prospective cohort study, Chi-Square Distribution, Obstetrics, Transmission (medicine), Vaginal delivery, business.industry, Infant, Newborn, virus diseases, Antibiotic Prophylaxis, Viral Load, medicine.disease, Infectious Disease Transmission, Vertical, Surgery, Infectious Diseases, Cohort, Female, business, Viral load, medicine.drug
Abstract

BACKGROUND: Intrapartum intravenous zidovudine (ZDV) prophylaxis is a long-standing component of prevention of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) in high-resource countries. In some recent guidelines, intravenous ZDV is no longer systematically recommended for mothers receiving combination antiretroviral therapy (cART) with low viral load. We evaluated the impact of intravenous ZDV according to viral load and obstetrical conditions. METHODS: All HIV-1-infected women delivering between 1 January 1997 and 31 December 2010 in the French Perinatal Cohort (ANRS-EPF) were analyzed if they received ART during pregnancy and did not breastfeed. We identified maternal and obstetrical characteristics related to lack of intravenous ZDV and compared its association with MTCT rate and other infant parameters, according to various risk factors. RESULTS: Intravenous ZDV was used in 95.2% of the 11 538 deliveries. Older age, multiparity, and preterm and vaginal delivery were associated with lack of intravenous ZDV (n = 554). In women who delivered with viral load ≥1000 copies/mL, the overall MTCT rate was higher without than with intravenous ZDV (7.5% vs 2.9%; P = .01); however, there was no such difference when the neonate received postnatal intensification therapy. Among them, 77% of women who had viral load

Published
2013

5. Increased risk of serious bacterial infections due to maternal immunosuppression in HIV-exposed uninfected infants in a European country

Author

Marie Medus, Vincent Gajdos, Laure Clech, Céline Goissen, Arnaud Chalvon Demersay, Virginie Zarouk, Louis Bernard, Pierre-François Ceccaldi, René-Charles Rudigoz, Patricia Murger, Philippe Le Moine, Catherine Chirouze, Mandovi Rajguru, Ludovic Cravello, Véronique Lefevre Elbert, Luminata Shneider, Guy Leverger, Tessa Goetghebuer, Kamila Kebaili, Eliane Galiba, Claudine Touboul, Françoise Meier, Didier Tardif, Dieudoné Ekoukou, Michèle Granier, Ahmed Zakaria, Corinne Cudeville, Laurence Benoist, Emilie Piet, Emmanuelle Vintejoux, Yves Hatchuel, Christophe Michau, Jean-Luc Schmidt, Michel Françoise, Claire Briandet, Stéphane Blanche, Philippe Bailly-Salin, Anne Vanderbergh, Jeanne Sibiude, Christiane Kommé, Benoît Martha, Camille Runel-Belliard, Claire Pluchart, Imad Nahri, Vincent Jeantils, François Hervé, Isabelle Hau, Agnès Lefort, Dominique Ayral, Delphine Peretti, Stéphanie Proust, Marie Belloy, Christine Rouzioux, Arnaud Boutet, Philippe Van de Perre, Elisabeth Broustal, Cécile Hafner Mauvais, Thierry Pistone, Marie-Dominique Tabone, Hélène Dauphin, Laurent Cotte, Clement Taron-Brocard, Jean-Marie Lang, Christine Boissinot, Antoine Doumet, André Bongain, Narcisse Elenga, Geneviève Mouchnino, Anne Boutemy, Christine Cheneau, Pascale Perfezou, Pierre Frange, Mathilde Niault, Christelle Dupre, Anne Chacé, Jean-Paul Teglas, Corinne Daniel, Sophie Matheron, Severine Ansart, Martine Levine, Fabienne Caby, Marc Duval-Arnould, Isabelle Metheron, Kareen Billiemaz, Albert Faye, Didier Armangaud, Yamina Hammou, Neila Elaoun, Anne Deville, Philippe Arsac, Lydie Sanchez, Odile Luycx Vaillant, Philippe Lumbroso, Marie-Gisèle Lebrette, Norbert Winer, Elise Maurel, Ramona Abrudan, Luc De Saint Martin, Françoise Jacquier, Christian Calvez, Fabrice Monpoux, Louis Mesnard, Marie-Aude Khuong-Josses, David Rey, Isabelle Belzic, Christine Allisy, Claire Genet, Hervé Seaume, Roland Tubiana, Jacques Reynes, Pascale Nau, Gilles Blondin, Eric Lachassine, Yves Poinsignon, Cédric Arvieux, Leila Karaoui, Anaïs Perilhou, Amélie Benbara, Marine Joras, Sophie Leautez-Nainville, Sophie Ducroix-Roubert, Raghad Moalim, Pascal Bolot, Jacques Gaillat, Olivier Bollengier Stragier, Alain Devidas, Muriel Lalande, Delphine Lemercier, Jean-Pierre Brossier, Emmanuelle Boutard, Isolde Pauly-Ravelly, Marie-Françoise Le Coz, Anne Grelier, Alain Alissa, Christiane De Gennes, Jean-Luc Delassus, Emmanuel Mortier, Faiza Ajana, Ghislaine Firtion, Alain Berrebi, Rose Nguyen, Sarah Ducrocq, Jean-Marc Chamouilli, Fabienne Mazy, Maïa Banigé, Khaled Mohamed, Natacha Entz-Werle, Jacques Brouard, Germaine Bachelard, Sandrine Delmas, Anne Constanty, Véronique Reliquet, Sophie Couderc, Florence Veber, Lahcene Allal, Catherine Crenn-Hebert, Blandine Muanza, Gaelle Pinto-Cardoso, Laurent Mandelbrot, Ama Johnson, Fabienne Messaoudi, Christian Burle, Josiane Warszawski, Bénédicte Carpentier, Dominique Brault, Suzanne Braig, Pascale Fialaire, Corinne Fourcade, Elisabeth Questiaux, Véronique Chambrin, Alain Lafeuillade, Véronique Hentgen, Yves Aubrard, Anne Borgne, Sandrine-Anne Martha, Evelyne Werner, Corinne Floch-Tudal, Agnès Bourgeois Moine, Corinne Routier, Jérôme Le Chenadec, Anne Coursol, Alain Fisher, Amélie Chabrol, Cécile Winter, Cécile Brunet-Cartier, Philippe Labrune, Claudine Cayla, Françoise Mazingue, Virginie Vitrat, Cyril Clavel, Michel Segondy, Ruxandra-Oana Calin, Lise Selleret, Pierre Weinbreck, Zaitoun Abdallah Moussa, Joël Gaudelus, Gaetane Mousset, Thomas Guimard, Agnès Villemant Uludag, Emmanuelle Pannier, Brigitte Clavier, Nicole Ciraru-Vigneron, Alain Checoury, Christophe Elleau, Manuela Bonmarchand, Catherine Dollfus, Joëlle Dendale-Nguyen, Adrien May, Pierre Chevojon, Claire Hubert, Constance Borie, Marialuisa Partisani, Elie Azria, Edouard Vaucel, Erianna Bellaton Marouts, Philippe Moreau, Jean-Luc Esnault, Mahfoud Rouha, Mary-France Courcoux, Brigitte Heller-Roussin, Gilles Hittinger, Christine Rouger, Lanto Ratsimbazafy, Jean-Marc Labaune, Mohamed Abdelhadi, Brigitte Elharrar, Joëlle Tricoire, Eric David, Hassan Safwan, Karine Guimard, Bruno Carbonne, Muriel Barat, Marion Dehlinger-Paul, Stéphane Bounan, Myriam Costa, Estelle Bauville, Didier Pinquier, Valérie Garrait, Etienne Dienga, Odile Launay, Zoha Maakroun, and Dominique Salmon Ceron

Subjects
Microbiology (medical), Pediatrics, medicine.medical_specialty, medicine.medical_treatment, Human immunodeficiency virus (HIV), HIV Infections, Kaplan-Meier Estimate, medicine.disease_cause, Infant, Newborn, Diseases, Pregnancy, medicine, Humans, Pregnancy Complications, Infectious, Retrospective Studies, business.industry, Proportional hazards model, Risk of infection, Hazard ratio, Infant, Newborn, Infant, Immunosuppression, Bacterial Infections, medicine.disease, Confidence interval, Infectious Disease Transmission, Vertical, CD4 Lymphocyte Count, Infectious Diseases, Immunology, Cohort, Female, France, business, Immunosuppressive Agents
Abstract

BACKGROUND Morbidity and mortality are higher among human immunodeficiency virus (HIV) exposed but uninfected (HEU) infants than unexposed infants, particularly if the mother had a low CD4 count. We investigated the possible association between maternal immune depression during pregnancy and the risk of infection in HEU infants in the national French Perinatal Cohort (EPF). METHODS All neonates, born alive, to HIV-1-infected women enrolled in the EPF between 2002 and 2010 were included. The primary outcome was the first serious (hospitalization or death) infection during the first year of life. The main exposure variable was maternal CD4 cell count near delivery. The Kaplan-Meier method and multivariate Cox models were applied, with the different types of infections managed as competing events. RESULTS Among 7638 HEU neonates, 699 had at least 1 serious infection (of which 159 were bacterial) with a Kaplan-Meier probability of 9.3% (95% confidence interval, 8.7-10.0) at 1 year. The risk of serious bacterial infection during the first year of life significantly increased with lower maternal CD4 cell count, before and after adjustment for maternal CD4 cell count

Published
2014

6. Maternal Virus Load during Pregnancy and Mother-to-Child Transmission of Human Immunodeficiency Virus Type 1: The French Perinatal Cohort Studies

Author

Christine Katlama, Jacques Isopet, Elisabeth Dussaix, Marie Christine Allemon, Claire Rekacewicz, Jean François Delfraissy, Laurent Mandelbrot, Véronique Chambrin, Jacqueline Puel, Nicole Ciraru-Vigneron, and Marie Jeanne Mayaux

Subjects
Pregnancy, medicine.medical_specialty, biology, Obstetrics, Transmission (medicine), business.industry, medicine.disease, biology.organism_classification, Virology, Virus, Infectious Diseases, Acquired immunodeficiency syndrome (AIDS), medicine, Immunology and Allergy, Gestation, Viral disease, Sida, business, Cohort study
Abstract

Virus load in pregnancy and its relation to mother-to-child human immunodeficiency virus (HIV) transmission were studied prospectively. From 1989 to 1994, 320 HIV-infected women from 18 centers had plasma samples stored. Among women not receiving antiretroviral therapy, the polymerase chain reaction RNA level was 3.6 log at delivery, and 15% of women had levels below the detection limit. There was no variation during pregnancy. Women born in sub-Saharan Africa had lower RNA levels, although their CD4 cell distribution did not differ from that in other women. Among 236 evaluable children, 19% +/- 5% were infected. Transmission occurred in 12% of cases (confidence interval, 5%-22%) with 10,000 copies/mL (P < .02). Maternal virus load appears strongly related to HIV transmission to the child.

Published
1997

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