Rajesh T. Gandhi, MD reviewing Mandelbrot L et al. Clin Infect Dis 2015 Dec 1.

In HIV-infected pregnant women who started therapy before conception and maintained virologic suppression, the rate of perinatal transmission was essentially zero.

One of the major successes of HIV prevention is the use of antiretroviral therapy (ART) in HIV-infected pregnant women to reduce rates of perinatal transmission. Now, investigators in France have quantified the effect of starting ART before conception on the likelihood of perinatal transmission. The HIV status of 8075 infants born to infected women from 2000 to 2011 in the French Perinatal Cohort was assessed. All mothers had received ART during pregnancy and did not breast-feed.

No perinatal transmission occurred in the 2651 infants whose mothers began ART before conception, continued treatment throughout pregnancy, and had viral loads <50 copies/mL near the time of delivery. Starting ART later in pregnancy and having a maternal viral load >50 copies/mL near the time of delivery were independent risk factors for perinatal transmission. A few perinatal transmissions occurred even when the maternal viral load was <50 copies/mL near delivery (14 transmissions from 2694 women); in all of these cases, women had started ART in the second or third trimester or had interrupted ART during pregnancy.

Citation(s):

Mandelbrot L et al. No perinatal HIV-1 transmission from women with effective antiretroviral therapy starting before conception. Clin Infect Dis 2015 Dec 1; 61:1715.

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