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 language | English |
|---|---|
| Pages (from-to) | 915-921 |
| Number of pages | 7 |
| Journal | Archives of Pediatrics and Adolescent Medicine |
| Volume | 156 |
| Issue number | 9 |
| Publication status | Published - Sep 1 2002 |
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ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
Cite this
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 journal › Article
}
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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M3 - Article
VL - 156
SP - 915
EP - 921
JO - Archives of Pediatrics and Adolescent Medicine
JF - Archives of Pediatrics and Adolescent Medicine
SN - 1072-4710
IS - 9
ER -