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August 10, 1994

Prospective Comparison of Mother-to-Child Transmission of HIV-1 and HIV-2 in Abidjan, Ivory Coast

Author Affiliations

From Projet RETRO-CI, Abidjan, Ivory Coast (Drs Adjorlolo-Johnson, De Cock, Ekpini, and Sibailly, Mss Vetter and Brattegaard, and Messrs Yavo, Doorly, and Whitaker); the Division of HIV/AIDS, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga (Drs De Cock, Ou, George, and Gayle, and Mr Whitaker); Emory University School of Public Health, Atlanta, Ga (Ms Vetter); and the Department of Immunology, Institute of Tropical Medicine, Antwerp, Belgium (Dr Kestens). Dr De Cock is now with the Department of Clinical Sciences, London (England) School of Hygiene and Tropical Medicine.

JAMA. 1994;272(6):462-466. doi:10.1001/jama.1994.03520060062033

Objective.  —To compare mother-to-child transmission of human immunodeficiency virus types 1 and 2 (HIV-1 and HIV-2, respectively) and to assess the impact of maternal HIV-1 and HIV-2 infections on child survival.

Design.  —Prospective cohort study.

Setting.  —Maternal and child health center in a lower socioeconomic class district of Abidjan, Ivory Coast.

Participants.  —A total of 18 099 women delivering between 1990 and 1992 were tested for HIV-1 and HIV-2 antibodies. A cohort of 613 pregnant women and their infants was followed prospectively (138 women reactive to HIV-1,132 reactive to HIV-2, 69 reactive to both viruses, and 274 HIV-seronegative). Main Outcome Measures.—Rates of perinatal transmission for HIV-1, HIV-2, and both viruses, determined from results of serological and polymerase chain reaction tests on children; survival of infants born to HIV-1—positive, HIV-2—positive, dually reactive, and HIV-seronegative women.

Results.  —Of the 18 099 women tested, 9.4% were reactive to HIV-1 alone, 1.6% to HIV-2 alone, and 1.0% to both viruses. The rate of perinatal transmission of HIV-1 was 24.7% (95% confidence interval [CI], 15.8% to 33.7%), compared with 1.2% (95% CI, 0.0% to 3.5%) for HIV-2 (relative risk, 21.3; 95% CI, 2.9 to 154.3). Overall, 19.0% (95% CI, 9.0% to 29.0%) of infants of dually reactive women became infected; of the 11 children concerned, 10 were infected with HIV-1 and one with HIV-1 and HIV-2. Infants of HIV-seropositive mothers had a reduced survival; mortality rates were 15.1, 13.0, 6.5, and 3.4 deaths per 100 child-years, respectively, for children of HIV-1—positive, dually reactive, HIV-2—positive, and HIV-seronegative women.

Conclusions.  —The rate of perinatal transmission of HIV-2 (1.2%) was much lower than the rate of perinatal transmission of HIV-1 (24.7%), and this was associated with more favorable survival for infants of HIV-2—infected mothers. Dually reactive women could transmit both viruses, although transmission usually involved HIV-1 only. Public health guidelines should incorporate advice that perinatal transmission of HIV-2 is rare.(JAMA. 1994;272:462-466)