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participating institutions:
Johns Hopkins University AIDS Service, New York State DOH AIDS Institute, The CORE Center, Cook County Hospital



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Perinatal Transmission of Human Immunodeficiency Virus Type 1 by Pregnant Women with RNA Virus Loads <1000 Copies/mL [Ioannidis JPA, et al. JID 2001;183:539]: The authors review seven prospective studies of perinatal transmission in Europe and the U.S. There were 44 cases of vertical HIV transmission among 1,202 women with viral loads <1000 c/mL at delivery or at measurement closest to delivery. The transmission rate was 8/834 (1%) in those who received antiretroviral therapy, and it was 36/368 (9.8%) for untreated mothers. The authors conclude that perinatal transmission is only about 1% in treated women with viral loads <1000 c/mL, but is nearly 10-fold higher in those with low viral loads without treatment.
Comment: There are some profound messages in this report. The prior recommendation has been to treat pregnant women according to the same guidelines that apply to other patients with regard to indications to initiate therapy, which is wrong. Pregnant women should be treated with antiretroviral agents to reduce perinatal transmission regardless of the CD4 cell count and baseline viral loads.
posted 3/1/2001





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