Journal Article

Mother-to-Child Transmission of HIV-2 Infection from 1986 to 2007 in the ANRS French Perinatal Cohort EPF-CO1

M. Burgard, C. Jasseron, S. Matheron, F. Damond, K. Hamrene, S. Blanche, A. Faye, C. Rouzioux, J. Warszawski and L. Mandelbrot

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 51, issue 7, pages 833-843
Published in print October 2010 | ISSN: 1058-4838
Published online October 2010 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/656284
Mother-to-Child Transmission of HIV-2 Infection from 1986 to 2007 in the ANRS French Perinatal Cohort EPF-CO1

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Background. Management of pregnant women with human immunodeficiency virus (HIV) type 2 infection remains unclear because of its low prevalence and important differences from HIV-1.

Methods. Pregnant women monoinfected with HIV-2 or HIV-1 and their infants enrolled in the prospective, national, multicenter French Perinatal Cohort between 1986 and 2007.

Results. Overall, 2.6% (223/8660) of mothers were infected with HIV-2, and they accounted for 3.1% (367/11841) of the total births. Most were born in sub-Saharan Africa. A higher proportion of HIV-2-infected mothers than HIV-1-infected mothers had no symptoms, had received no antiretroviral threrapy at conception (85.9% vs 66.7%), and had received no antiretroviral therapy during pregnancy (42.8% vs 19.9%), particularly highly active antiretroviral therapy (HAART) (79.7% vs 46.1%), and they had higher CD4 cell counts near delivery (median, 574 vs 452 cells/mm3; P < .01). If antiretroviral therapy was used, it was started at a later gestational age for HIV-2-infected mothers (median, 28 vs 25 weeks; P < .01). HIV-2-infected mothers were more likely to deliver vaginally (67.9% vs 49.3%) and to breastfeed (3.6% vs 0.6%; P < .01), and their infants less frequently received postexposure prophylaxis. In the period 2000–2007, the proportion with viral load <100 copies/mL at delivery was 90.5% of HIV-2-infected mothers, compared with 76.2% of HIV-1-infected mothers (P = .1). There were 2 cases of transmission: 1 case in 1993 occurred following maternal primary infection, and the other case occurred postnatally in 2002 and involved a mother with severe immune deficiency. The mother-to-child transmission rate for HIV-2 was 0.6% (95% confidence interval, 0.07%–2.2%).

Conclusions. Care for HIV-2-infected pregnant women rests on expert opinion. The mother-to-child transmission residual rate (0.07%–2.2%) argues for systematic treatment: protease inhibitor-based HAART for women requiring antiretroviral therapy or for primary infection and simplified prevention of mother-to-child transmission in other instances.

Journal Article.  5395 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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