Determinants of mother-to-infant human immunodeficiency virus 1 transmission before and after the introduction of zidovudine prophylaxis

Maurizio de Martino, Luisa Galli, Pier Angelo Tovo, Clara Gabiano, Patrizio Pezzotti, Theresa M. Wagner, Giovanni Rezza, P. Osimani, D. De Mattia, C. Di Bari, M. Ruggeri, F. Baldi, M. Ciccia, M. Lanari, M. Masi, V. Venturi, L. Battisti, M. Duse, P. G. Chiriacò, R. Cavallini & 61 others C. Dessí, C. Pintor, E. Anastasio, G. Sabatino, M. Sticca, G. Pomero, T. Bezzi, E. Chiappini, M. De Luca, P. Gervaso, M. T. Cecchi, D. Bassetti, C. Gotta, R. Rosso, A. Timitilli, U. Tondo, P. Mussini, D. Bricalli, A. Bucceri, G. Ferraris, M. Giovannini, F. Mosca, R. Lipreri, A. Plebani, E. Riva, S. Riva, A. Viganò, G. V. Zuccotti, M. Cellini, W. Buffolano, A. Guarino, L. Tarallo, R. D'Elia, C. Giaquinto, O. Rampon, E. R. Dalle Nogare, A. Romano, D. Caselli, A. Maccabruni, R. Consolini, G. Benaglia, C. Magnani, G. Anzidei, A. M. Casadei Pistilli, G. Castelli Gattinara, S. Catania, C. Facente, P. Falconieri, C. Fundarò, O. Genovese, C. Rendeli, S. Bionda, L. Cristiano, S. Garetto, C. Riva, E. Palomba, V. Portelli, A. Mazza, C. Salvatore, A. Pellegatta, M. Molesini

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: Randomized controlled trials have demonstrated that zidovudine therapy decreases the mother-to-infant transmission of human immunodeficiency virus 1 (HIV-1). Data from large observational studies may provide further important findings on the effectiveness at the population level of combined treatments in decreasing transmission. Objective: To evaluate time trends in prophylactic interventions and the determinants of transmission both before and after the introduction of antiretroviral prophylaxis, and in treated and untreated mother-infant pairs after 1995. Design and Setting: Analysis of prospective data on 3770 children born to HIV-1-infected women between 1985 and 1999 and reported to the Italian Register for HIV Infection in Children. Main Outcome Measures: Logistic regression random effects models were used to estimate crude and adjusted odds ratios for several factors potentially influencing vertical transmission for 2 periods - 1985 through 1995 (January 1, 1985, through December 31, 1995) and 1996 through 1999 (January 1, 1996, through December 31, 1999), and between treated and untreated children after 1995. Results: The transmission rate was 15.5% in the 1985-1995 period and 5.8% in the 1996-1999 period. By 1999, prophylactic interventions had greatly increased. Antiretroviral treatment (ART) usage was 89.9%, (55.1% combination ART) and the elective cesarean delivery rate was 81.3%. In multivariate analysis, only elective cesarean delivery was associated with a lower risk of mother-to-infant transmission before 1995. After 1995, nonbreastfeeding and receipt of ART were protective whereas elective cesarean delivery was not significantly protective in multivariate analysis. Transmission risk was reduced by 76% with an incomplete zidovudine regimen, 88% with a complete regimen, and 93% when the mother received combination ART. In the 1996-1999 period, the transmission rate for nonbreastfeeding mother-infant pairs was 8.6% with elective cesarean delivery, 4.4% with any ART, and 2.4% with these interventions combined. Conclusion: Prophylactic interventions, and in particular ART, reduced perinatal HIV-1 transmission at a population level in Italy.

Original languageEnglish
Pages (from-to)915-921
Number of pages7
JournalArchives of Pediatrics and Adolescent Medicine
Volume156
Issue number9
Publication statusPublished - Sep 1 2002

Fingerprint

Zidovudine
HIV-1
Mothers
Therapeutics
Multivariate Analysis
Italy
Population
HIV Infections
Observational Studies
Randomized Controlled Trials
Logistic Models
Odds Ratio
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

de Martino, M., Galli, L., Tovo, P. A., Gabiano, C., Pezzotti, P., Wagner, T. M., ... Molesini, M. (2002). Determinants of mother-to-infant human immunodeficiency virus 1 transmission before and after the introduction of zidovudine prophylaxis. Archives of Pediatrics and Adolescent Medicine, 156(9), 915-921.

Determinants of mother-to-infant human immunodeficiency virus 1 transmission before and after the introduction of zidovudine prophylaxis. / de Martino, Maurizio; Galli, Luisa; Tovo, Pier Angelo; Gabiano, Clara; Pezzotti, Patrizio; Wagner, Theresa M.; Rezza, Giovanni; Osimani, P.; De Mattia, D.; Di Bari, C.; Ruggeri, M.; Baldi, F.; Ciccia, M.; Lanari, M.; Masi, M.; Venturi, V.; Battisti, L.; Duse, M.; Chiriacò, P. G.; Cavallini, R.; Dessí, C.; Pintor, C.; Anastasio, E.; Sabatino, G.; Sticca, M.; Pomero, G.; Bezzi, T.; Chiappini, E.; De Luca, M.; Gervaso, P.; Cecchi, M. T.; Bassetti, D.; Gotta, C.; Rosso, R.; Timitilli, A.; Tondo, U.; Mussini, P.; Bricalli, D.; Bucceri, A.; Ferraris, G.; Giovannini, M.; Mosca, F.; Lipreri, R.; Plebani, A.; Riva, E.; Riva, S.; Viganò, A.; Zuccotti, G. V.; Cellini, M.; Buffolano, W.; Guarino, A.; Tarallo, L.; D'Elia, R.; Giaquinto, C.; Rampon, O.; Dalle Nogare, E. R.; Romano, A.; Caselli, D.; Maccabruni, A.; Consolini, R.; Benaglia, G.; Magnani, C.; Anzidei, G.; Casadei Pistilli, A. M.; Castelli Gattinara, G.; Catania, S.; Facente, C.; Falconieri, P.; Fundarò, C.; Genovese, O.; Rendeli, C.; Bionda, S.; Cristiano, L.; Garetto, S.; Riva, C.; Palomba, E.; Portelli, V.; Mazza, A.; Salvatore, C.; Pellegatta, A.; Molesini, M.

In: Archives of Pediatrics and Adolescent Medicine, Vol. 156, No. 9, 01.09.2002, p. 915-921.

Research output: Contribution to journalArticle

de Martino, M, Galli, L, Tovo, PA, Gabiano, C, Pezzotti, P, Wagner, TM, Rezza, G, Osimani, P, De Mattia, D, Di Bari, C, Ruggeri, M, Baldi, F, Ciccia, M, Lanari, M, Masi, M, Venturi, V, Battisti, L, Duse, M, Chiriacò, PG, Cavallini, R, Dessí, C, Pintor, C, Anastasio, E, Sabatino, G, Sticca, M, Pomero, G, Bezzi, T, Chiappini, E, De Luca, M, Gervaso, P, Cecchi, MT, Bassetti, D, Gotta, C, Rosso, R, Timitilli, A, Tondo, U, Mussini, P, Bricalli, D, Bucceri, A, Ferraris, G, Giovannini, M, Mosca, F, Lipreri, R, Plebani, A, Riva, E, Riva, S, Viganò, A, Zuccotti, GV, Cellini, M, Buffolano, W, Guarino, A, Tarallo, L, D'Elia, R, Giaquinto, C, Rampon, O, Dalle Nogare, ER, Romano, A, Caselli, D, Maccabruni, A, Consolini, R, Benaglia, G, Magnani, C, Anzidei, G, Casadei Pistilli, AM, Castelli Gattinara, G, Catania, S, Facente, C, Falconieri, P, Fundarò, C, Genovese, O, Rendeli, C, Bionda, S, Cristiano, L, Garetto, S, Riva, C, Palomba, E, Portelli, V, Mazza, A, Salvatore, C, Pellegatta, A & Molesini, M 2002, 'Determinants of mother-to-infant human immunodeficiency virus 1 transmission before and after the introduction of zidovudine prophylaxis', Archives of Pediatrics and Adolescent Medicine, vol. 156, no. 9, pp. 915-921.
de Martino, Maurizio ; Galli, Luisa ; Tovo, Pier Angelo ; Gabiano, Clara ; Pezzotti, Patrizio ; Wagner, Theresa M. ; Rezza, Giovanni ; Osimani, P. ; De Mattia, D. ; Di Bari, C. ; Ruggeri, M. ; Baldi, F. ; Ciccia, M. ; Lanari, M. ; Masi, M. ; Venturi, V. ; Battisti, L. ; Duse, M. ; Chiriacò, P. G. ; Cavallini, R. ; Dessí, C. ; Pintor, C. ; Anastasio, E. ; Sabatino, G. ; Sticca, M. ; Pomero, G. ; Bezzi, T. ; Chiappini, E. ; De Luca, M. ; Gervaso, P. ; Cecchi, M. T. ; Bassetti, D. ; Gotta, C. ; Rosso, R. ; Timitilli, A. ; Tondo, U. ; Mussini, P. ; Bricalli, D. ; Bucceri, A. ; Ferraris, G. ; Giovannini, M. ; Mosca, F. ; Lipreri, R. ; Plebani, A. ; Riva, E. ; Riva, S. ; Viganò, A. ; Zuccotti, G. V. ; Cellini, M. ; Buffolano, W. ; Guarino, A. ; Tarallo, L. ; D'Elia, R. ; Giaquinto, C. ; Rampon, O. ; Dalle Nogare, E. R. ; Romano, A. ; Caselli, D. ; Maccabruni, A. ; Consolini, R. ; Benaglia, G. ; Magnani, C. ; Anzidei, G. ; Casadei Pistilli, A. M. ; Castelli Gattinara, G. ; Catania, S. ; Facente, C. ; Falconieri, P. ; Fundarò, C. ; Genovese, O. ; Rendeli, C. ; Bionda, S. ; Cristiano, L. ; Garetto, S. ; Riva, C. ; Palomba, E. ; Portelli, V. ; Mazza, A. ; Salvatore, C. ; Pellegatta, A. ; Molesini, M. / Determinants of mother-to-infant human immunodeficiency virus 1 transmission before and after the introduction of zidovudine prophylaxis. In: Archives of Pediatrics and Adolescent Medicine. 2002 ; Vol. 156, No. 9. pp. 915-921.
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title = "Determinants of mother-to-infant human immunodeficiency virus 1 transmission before and after the introduction of zidovudine prophylaxis",
abstract = "Background: Randomized controlled trials have demonstrated that zidovudine therapy decreases the mother-to-infant transmission of human immunodeficiency virus 1 (HIV-1). Data from large observational studies may provide further important findings on the effectiveness at the population level of combined treatments in decreasing transmission. Objective: To evaluate time trends in prophylactic interventions and the determinants of transmission both before and after the introduction of antiretroviral prophylaxis, and in treated and untreated mother-infant pairs after 1995. Design and Setting: Analysis of prospective data on 3770 children born to HIV-1-infected women between 1985 and 1999 and reported to the Italian Register for HIV Infection in Children. Main Outcome Measures: Logistic regression random effects models were used to estimate crude and adjusted odds ratios for several factors potentially influencing vertical transmission for 2 periods - 1985 through 1995 (January 1, 1985, through December 31, 1995) and 1996 through 1999 (January 1, 1996, through December 31, 1999), and between treated and untreated children after 1995. Results: The transmission rate was 15.5{\%} in the 1985-1995 period and 5.8{\%} in the 1996-1999 period. By 1999, prophylactic interventions had greatly increased. Antiretroviral treatment (ART) usage was 89.9{\%}, (55.1{\%} combination ART) and the elective cesarean delivery rate was 81.3{\%}. In multivariate analysis, only elective cesarean delivery was associated with a lower risk of mother-to-infant transmission before 1995. After 1995, nonbreastfeeding and receipt of ART were protective whereas elective cesarean delivery was not significantly protective in multivariate analysis. Transmission risk was reduced by 76{\%} with an incomplete zidovudine regimen, 88{\%} with a complete regimen, and 93{\%} when the mother received combination ART. In the 1996-1999 period, the transmission rate for nonbreastfeeding mother-infant pairs was 8.6{\%} with elective cesarean delivery, 4.4{\%} with any ART, and 2.4{\%} with these interventions combined. Conclusion: Prophylactic interventions, and in particular ART, reduced perinatal HIV-1 transmission at a population level in Italy.",
author = "{de Martino}, Maurizio and Luisa Galli and Tovo, {Pier Angelo} and Clara Gabiano and Patrizio Pezzotti and Wagner, {Theresa M.} and Giovanni Rezza and P. Osimani and {De Mattia}, D. and {Di Bari}, C. and M. Ruggeri and F. Baldi and M. Ciccia and M. Lanari and M. Masi and V. Venturi and L. Battisti and M. Duse and Chiriac{\`o}, {P. G.} and R. Cavallini and C. Dess{\'i} and C. Pintor and E. Anastasio and G. Sabatino and M. Sticca and G. Pomero and T. Bezzi and E. Chiappini and {De Luca}, M. and P. Gervaso and Cecchi, {M. T.} and D. Bassetti and C. Gotta and R. Rosso and A. Timitilli and U. Tondo and P. Mussini and D. Bricalli and A. Bucceri and G. Ferraris and M. Giovannini and F. Mosca and R. Lipreri and A. Plebani and E. Riva and S. Riva and A. Vigan{\`o} and Zuccotti, {G. V.} and M. Cellini and W. Buffolano and A. Guarino and L. Tarallo and R. D'Elia and C. Giaquinto and O. Rampon and {Dalle Nogare}, {E. R.} and A. Romano and D. Caselli and A. Maccabruni and R. Consolini and G. Benaglia and C. Magnani and G. Anzidei and {Casadei Pistilli}, {A. M.} and {Castelli Gattinara}, G. and S. Catania and C. Facente and P. Falconieri and C. Fundar{\`o} and O. Genovese and C. Rendeli and S. Bionda and L. Cristiano and S. Garetto and C. Riva and E. Palomba and V. Portelli and A. Mazza and C. Salvatore and A. Pellegatta and M. Molesini",
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TY - JOUR

T1 - Determinants of mother-to-infant human immunodeficiency virus 1 transmission before and after the introduction of zidovudine prophylaxis

AU - de Martino, Maurizio

AU - Galli, Luisa

AU - Tovo, Pier Angelo

AU - Gabiano, Clara

AU - Pezzotti, Patrizio

AU - Wagner, Theresa M.

AU - Rezza, Giovanni

AU - Osimani, P.

AU - De Mattia, D.

AU - Di Bari, C.

AU - Ruggeri, M.

AU - Baldi, F.

AU - Ciccia, M.

AU - Lanari, M.

AU - Masi, M.

AU - Venturi, V.

AU - Battisti, L.

AU - Duse, M.

AU - Chiriacò, P. G.

AU - Cavallini, R.

AU - Dessí, C.

AU - Pintor, C.

AU - Anastasio, E.

AU - Sabatino, G.

AU - Sticca, M.

AU - Pomero, G.

AU - Bezzi, T.

AU - Chiappini, E.

AU - De Luca, M.

AU - Gervaso, P.

AU - Cecchi, M. T.

AU - Bassetti, D.

AU - Gotta, C.

AU - Rosso, R.

AU - Timitilli, A.

AU - Tondo, U.

AU - Mussini, P.

AU - Bricalli, D.

AU - Bucceri, A.

AU - Ferraris, G.

AU - Giovannini, M.

AU - Mosca, F.

AU - Lipreri, R.

AU - Plebani, A.

AU - Riva, E.

AU - Riva, S.

AU - Viganò, A.

AU - Zuccotti, G. V.

AU - Cellini, M.

AU - Buffolano, W.

AU - Guarino, A.

AU - Tarallo, L.

AU - D'Elia, R.

AU - Giaquinto, C.

AU - Rampon, O.

AU - Dalle Nogare, E. R.

AU - Romano, A.

AU - Caselli, D.

AU - Maccabruni, A.

AU - Consolini, R.

AU - Benaglia, G.

AU - Magnani, C.

AU - Anzidei, G.

AU - Casadei Pistilli, A. M.

AU - Castelli Gattinara, G.

AU - Catania, S.

AU - Facente, C.

AU - Falconieri, P.

AU - Fundarò, C.

AU - Genovese, O.

AU - Rendeli, C.

AU - Bionda, S.

AU - Cristiano, L.

AU - Garetto, S.

AU - Riva, C.

AU - Palomba, E.

AU - Portelli, V.

AU - Mazza, A.

AU - Salvatore, C.

AU - Pellegatta, A.

AU - Molesini, M.

PY - 2002/9/1

Y1 - 2002/9/1

N2 - Background: Randomized controlled trials have demonstrated that zidovudine therapy decreases the mother-to-infant transmission of human immunodeficiency virus 1 (HIV-1). Data from large observational studies may provide further important findings on the effectiveness at the population level of combined treatments in decreasing transmission. Objective: To evaluate time trends in prophylactic interventions and the determinants of transmission both before and after the introduction of antiretroviral prophylaxis, and in treated and untreated mother-infant pairs after 1995. Design and Setting: Analysis of prospective data on 3770 children born to HIV-1-infected women between 1985 and 1999 and reported to the Italian Register for HIV Infection in Children. Main Outcome Measures: Logistic regression random effects models were used to estimate crude and adjusted odds ratios for several factors potentially influencing vertical transmission for 2 periods - 1985 through 1995 (January 1, 1985, through December 31, 1995) and 1996 through 1999 (January 1, 1996, through December 31, 1999), and between treated and untreated children after 1995. Results: The transmission rate was 15.5% in the 1985-1995 period and 5.8% in the 1996-1999 period. By 1999, prophylactic interventions had greatly increased. Antiretroviral treatment (ART) usage was 89.9%, (55.1% combination ART) and the elective cesarean delivery rate was 81.3%. In multivariate analysis, only elective cesarean delivery was associated with a lower risk of mother-to-infant transmission before 1995. After 1995, nonbreastfeeding and receipt of ART were protective whereas elective cesarean delivery was not significantly protective in multivariate analysis. Transmission risk was reduced by 76% with an incomplete zidovudine regimen, 88% with a complete regimen, and 93% when the mother received combination ART. In the 1996-1999 period, the transmission rate for nonbreastfeeding mother-infant pairs was 8.6% with elective cesarean delivery, 4.4% with any ART, and 2.4% with these interventions combined. Conclusion: Prophylactic interventions, and in particular ART, reduced perinatal HIV-1 transmission at a population level in Italy.

AB - Background: Randomized controlled trials have demonstrated that zidovudine therapy decreases the mother-to-infant transmission of human immunodeficiency virus 1 (HIV-1). Data from large observational studies may provide further important findings on the effectiveness at the population level of combined treatments in decreasing transmission. Objective: To evaluate time trends in prophylactic interventions and the determinants of transmission both before and after the introduction of antiretroviral prophylaxis, and in treated and untreated mother-infant pairs after 1995. Design and Setting: Analysis of prospective data on 3770 children born to HIV-1-infected women between 1985 and 1999 and reported to the Italian Register for HIV Infection in Children. Main Outcome Measures: Logistic regression random effects models were used to estimate crude and adjusted odds ratios for several factors potentially influencing vertical transmission for 2 periods - 1985 through 1995 (January 1, 1985, through December 31, 1995) and 1996 through 1999 (January 1, 1996, through December 31, 1999), and between treated and untreated children after 1995. Results: The transmission rate was 15.5% in the 1985-1995 period and 5.8% in the 1996-1999 period. By 1999, prophylactic interventions had greatly increased. Antiretroviral treatment (ART) usage was 89.9%, (55.1% combination ART) and the elective cesarean delivery rate was 81.3%. In multivariate analysis, only elective cesarean delivery was associated with a lower risk of mother-to-infant transmission before 1995. After 1995, nonbreastfeeding and receipt of ART were protective whereas elective cesarean delivery was not significantly protective in multivariate analysis. Transmission risk was reduced by 76% with an incomplete zidovudine regimen, 88% with a complete regimen, and 93% when the mother received combination ART. In the 1996-1999 period, the transmission rate for nonbreastfeeding mother-infant pairs was 8.6% with elective cesarean delivery, 4.4% with any ART, and 2.4% with these interventions combined. Conclusion: Prophylactic interventions, and in particular ART, reduced perinatal HIV-1 transmission at a population level in Italy.

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