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    Characteristics and management of HIV-1-infected pregnant women enrolled in a randomised trial: differences between Europe and the USA

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    bmc_infectious_diseases_1471_2 ...
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    Authors
    Newell, Marie-Louise
    Huang, Sharon
    Fiore, Simona
    Thorne, Claire
    Mandelbrot, Laurent
    Sullivan, John L.
    Maupin, Robert
    Delke, Isaac
    Watts, D. Heather
    Gelber, Richard D.
    Cunningham, Coleen K.
    Show allShow less
    UMass Chan Affiliations
    Program in Molecular Medicine
    Department of Pediatrics
    Document Type
    Journal Article
    Publication Date
    2007-06-20
    Keywords
    Abortion, Spontaneous
    Adult
    Antiretroviral Therapy, Highly Active
    Cesarean Section
    Cohort Studies
    Europe
    Female
    Gestational Age
    HIV Infections
    HIV-1
    Humans
    Infant, Newborn
    Infectious Disease Transmission, Vertical
    and numerical data
    Pregnancy
    Pregnancy Complications, Infectious
    Pregnancy Outcome
    Risk Factors
    United States
    Viral Load
    Heterocyclic Compounds
    Immunology and Infectious Disease
    Maternal and Child Health
    Pediatrics
    Pharmaceutical Preparations
    Reproductive and Urinary Physiology
    Therapeutics
    Viruses
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    Abstract
    BACKGROUND: Rates of mother-to-child transmission of HIV-1 (MTCT) have historically been lower in European than in American cohort studies, possibly due to differences in population characteristics. The Pediatric AIDS Clinical Trials Group Protocol (PACTG) 316 trial evaluated the effectiveness of the addition of intrapartum/neonatal nevirapine in reducing MTCT in women already receiving antiretroviral prophylaxis. Participation of large numbers of pregnant HIV-infected women from the US and Western Europe enrolling in the same clinical trial provided the opportunity to identify and explore differences in their characteristics and in the use of non-study interventions to reduce MTCT. METHODS: In this secondary analysis, 1350 women were categorized according to enrollment in centres in the USA (n = 978) or in Europe (n = 372). Factors associated with receipt of highly active antiretroviral therapy and with elective caesarean delivery were identified with logistic regression. RESULTS: In Europe, women enrolled were more likely to be white and those of black race were mainly born in Sub-Saharan Africa. Women in the US were younger and more likely to have previous pregnancies and miscarriages and a history of sexually transmitted infections. More than 90% of women did not report symptoms of their HIV infection; however, more women from the US had symptoms (8%), compared to women from Europe (4%). Women in the US were less likely to have HIV RNA levels /ml at delivery than women enrolling in Europe, and more likely to receive highly active antiretroviral therapy, and to start therapy earlier in pregnancy. The elective caesarean delivery rate in Europe was 61%, significantly higher than that in the US (22%). Overall, 1.48% of infants were infected and there was no significant difference in the rate of transmission between Europe and the US despite the different approaches to treatment and delivery. CONCLUSION: These findings confirm that there are important historical differences between the HIV-infected pregnant populations in Western Europe and the USA, both in terms of the characteristics of the women and their obstetric and therapeutic management. Although highly active antiretroviral therapy predominates in pregnancy in both settings now, population differences are likely to remain. TRIAL REGISTRATION: NCT00000869.
    Source

    BMC Infect Dis. 2007 Jun 20;7:60. doi:10.1186/1471-2334-7-60. Link to article on publisher's site

    DOI
    10.1186/1471-2334-7-60
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/43472
    PubMed ID
    17584491
    Related Resources

    Link to Article in PubMed

    Rights
    This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2007 Newell et al; licensee BioMed Central Ltd.
    ae974a485f413a2113503eed53cd6c53
    10.1186/1471-2334-7-60
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