Combined evaluation of sexually transmitted infections in HIV-infected pregnant women and infant HIV transmission

Kristina Adachi, Jiahong Xu, Nava Yeganeh, Margaret Camarca, Mariza G Morgado, D Heather Watts, Lynne M Mofenson, Valdilea G Veloso, Jose Henrique Pilotto, Esau Joao, Glenda Gray, Gerhard Theron, Breno Santos, Rosana Fonseca, Regis Kreitchmann, Jorge Pinto, Marisa M Mussi-Pinhata, Mariana Ceriotto, Daisy Maria Machado, Yvonne J Bryson, Beatriz Grinsztejn, Jack Moye, Jeffrey D Klausner, Claire C Bristow, Ruth Dickover, Mark Mirochnick, Karin Nielsen-Saines, NICHD HPTN 040 Study Team, Kristina Adachi, Jiahong Xu, Nava Yeganeh, Margaret Camarca, Mariza G Morgado, D Heather Watts, Lynne M Mofenson, Valdilea G Veloso, Jose Henrique Pilotto, Esau Joao, Glenda Gray, Gerhard Theron, Breno Santos, Rosana Fonseca, Regis Kreitchmann, Jorge Pinto, Marisa M Mussi-Pinhata, Mariana Ceriotto, Daisy Maria Machado, Yvonne J Bryson, Beatriz Grinsztejn, Jack Moye, Jeffrey D Klausner, Claire C Bristow, Ruth Dickover, Mark Mirochnick, Karin Nielsen-Saines, NICHD HPTN 040 Study Team

Abstract

Background: Sexually transmitted infections (STIs) including Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Treponema pallidum (TP), and cytomegalovirus (CMV) may lead to adverse pregnancy and infant outcomes. The role of combined maternal STIs in HIV mother-to-child transmission (MTCT) was evaluated in mother-infant pairs from NICHD HPTN 040.

Methodology: Urine samples from HIV-infected pregnant women during labor were tested by polymerase chain reaction (PCR) for CT, NG, and CMV. Infant HIV infection was determined by serial HIV DNA PCR testing. Maternal syphilis was tested by VDRL and confirmatory treponemal antibodies.

Results: A total of 899 mother-infant pairs were evaluated. Over 30% had at least one of the following infections (TP, CT, NG, and/or CMV) detected at the time of delivery. High rates of TP (8.7%), CT (17.8%), NG (4%), and CMV (6.3%) were observed. HIV MTCT was 9.1% (n = 82 infants). HIV MTCT was 12.5%, 10.3%, 11.1%, and 26.3% among infants born to women with CT, TP, NG or CMV respectively. Forty-two percent of HIV-infected infants were born to women with at least one of these 4 infections. Women with these infections were nearly twice as likely to have an HIV-infected infant (aOR 1.9, 95% CI 1.1-3.0), particularly those with 2 STIs (aOR 3.4, 95% CI 1.5-7.7). Individually, maternal CMV (aOR 4.4 1.5-13.0) and infant congenital CMV (OR 4.1, 95% CI 2.2-7.8) but not other STIs (TP, CT, or NG) were associated with an increased risk of HIV MTCT.

Conclusion: HIV-infected pregnant women identified during labor are at high risk for STIs. Co-infection with STIs including CMV nearly doubles HIV MTCT risk. CMV infection appears to confer the largest risk of HIV MTCT.

Trial registration: NCT00099359.

Conflict of interest statement

Competing Interests: We have the following interests: Co-author Margaret Camarca is employed by Westat, and co-author Jiahong Xu is a former employee of Westat. Funding was received from commercial sources for the parent study HPTN 040 clinical trial from Boehringer Ingelheim Pharmaceuticals Inc. (BIPI), and GlaxoSmithKline, on behalf of ViiV Healthcare, all of which donated antiretrovirals for the conduct of the primary parent study evaluating neonatal prophylaxis. Support was also received from Cepheid for the testing of CT and NG during the implementation of another previous HPTN 040 sub-study. There are no patents, products in development or marketed products to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials.

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