HIV-RNA levels during pregnancy and vertical transmission of HIV-I

Objective To assess changes ti HIV-1 RNA copy number (Copy#) during and after pregnancy and to examine the relationship between antepartum Copy# and vertical transmission of HIV-I. Methods: Plasma and serum obtained prior to the third trimester (prTM3), during TM3 (TM3), and two months postpartum (2MPP) from HIV-infected women enrolled in the Mother and Infants Cohort Study between 1986 and 1991 were frozen and stored at 70C until thawed and analyzed in batch using the Roche Monitor HIV-RNA assay. Results: There was little overall change in Copy# between prTM3 andTM3 (median difference for n=42 paired data. -143; p=0.45) orTM3 and 2MPP (n=87: median, ft p=0.61). TM3 data were available for 138 women, only six of whom received antiretroviral therapy during pregnancy (two transmitted, four did not): Copy# n No. (%) Trans. Estimated OR (95% Cl) < 1.000 20 0 0.15 (0.08-2.72) 1,000-9.999 52 7 (13.5) 1.0 P_M-H for trend 10,000-99.999 48 16 (33.3) 3.21 (1.21-852) =0.001 ≥100.000 18 6 (33.3) 3.21 (0.94-11.0) A similar overall association was seen when these data were analyzed using the Wilcoxon rank-sum test (p=0.004) and logistic regression analysis (p=0.002).The association persisted when CD4+ level and duration of ruptured membranes (DROM) were included in the logistic regression model (p=0.027). Conclusions: HIV-RNA Copy# was stable during pregnancy and the early postpartum period, suggesting that pregnancy has little general effect on this viral measure.There was a strong overall association betweenTM3 HIV-RNA Copy# and vertical transmission of HIV-I .This association was independent of CD4+ level and DROM.