Combined evaluation of sexually transmitted infections in HIV-infected pregnant women and infant HIV transmission

NICHD (NICHD) (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 NIH/NICHD 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. David Geffen UCLA Sch Med, Los Angeles, CA 90095 USA Westat Corp, Rockville, MD USA Fundacao Oswaldo Cruz FIOCRUZ, Rio De Janeiro, RJ, Brazil US Dept State, Off Global AIDS Coordinator, Washington, DC 20520 USA Elizabeth Glaser Pediat AIDS Fdn, Washington, DC USA Hosp Geral Nova Iguacu, Nova Iguacu, RJ, Brazil Hosp Fed Servidores Estado, Rio De Janeiro, RJ, Brazil Univ Witwatersrand, SAMRC & Perinatal HIV Res Unit, Johannesburg, South Africa Stellenbosch Univ, Tygerberg Hosp, Cape Town, South Africa Hosp Conceicao, Porto Alegre, RS, Brazil Hosp Femina, Porto Alegre, RS, Brazil Irmandade Santa Casa Misericordia Porto Alegre, Porto Alegre, RS, Brazil Univ Fed Minas Gerais, Belo Horizonte, MG, Brazil Univ Sao Paulo, Ribeirao Preto Med Sch, Sao Paulo, Brazil Fdn Maternal & Infant Hlth FUNDASAMIN, Buenos Aires, DF, Argentina Univ Fed Sao Paulo, Escola Paulista Med, Sao Paulo, SP, Brazil Eunice Kennedy Shriver Natl Inst Child Hlth & Hum, NIH, Bethesda, MD USA UCLA, Fielding Sch Publ Hlth, Los Angeles, CA USA UCSD Sch Med, La Jolla, CA USA UC Davis Sch Med, Davis, CA USA Boston Univ, Sch Med, Boston, MA 02118 USA Univ Fed Sao Paulo, Escola Paulista Med, Sao Paulo, SP, Brazil NICHD (NICHD): HHSN267200800001C, N01-HD-8-0001 Brazilian AIDS Prevention Trials International Network: NIAID/ NIH [U01 AI047986 National Institute of Allergy and Infectious Diseases (NIAID): U01 AI068632, UM1AI068632, UM1AI068616, UM1AI106716 NIMH: AI068632 NG in a prior HPTN :040 UCLA Center for AIDS Research (CFAR) NIH/ NIAID: AI02869, AI28697 NIH/NICHD: HHSN275201300003C Web of Science