Update of Perinatal Human Immunodeficiency Virus Type 1 Transmission in France: Zero Transmission for 5482 Mothers on Continuous Antiretroviral Therapy From Conception and With Undetectable Viral Load at Delivery

Jeanne Sibiude; Jérôme Le Chenadec; Laurent Mandelbrot; Alexandre Hoctin; Catherine Dollfus; Albert Faye; Eida Bui; Emmanuelle Pannier; Jade Ghosn; Valerie Garrait; Véronique Avettand-Fenoel; Pierre Frange; Josiane Warszawski; Roland Tubiana

doi:10.1093/cid/ciac703

Update of Perinatal Human Immunodeficiency Virus Type 1 Transmission in France: Zero Transmission for 5482 Mothers on Continuous Antiretroviral Therapy From Conception and With Undetectable Viral Load at Delivery

Clin Infect Dis. 2023 Feb 8;76(3):e590-e598. doi: 10.1093/cid/ciac703.

Authors

Jeanne Sibiude^{1

2}, Jérôme Le Chenadec³, Laurent Mandelbrot², Alexandre Hoctin³, Catherine Dollfus⁴, Albert Faye^{5

6}, Eida Bui⁷, Emmanuelle Pannier⁸, Jade Ghosn⁹, Valerie Garrait¹⁰, Véronique Avettand-Fenoel^{11

12}, Pierre Frange¹³, Josiane Warszawski^{14

15}, Roland Tubiana^{16

17}

Affiliations

¹ Department of Gynecology-Obstetrics, Assistance Publique des Hôpitaux de Paris Hôpital Louis Mourier, Colombes, France.
² Université de Paris, Infection, Antimicrobials, Modelling, Evolution UMR 1137, Institut national de la santé et de la recherche médicale, Paris, France.
³ Institut national de la santé et de la recherche médicale Centre d'Epidémiologie et de Santé des Populations U1018, Le Kremlin-Bicêtre, France.
⁴ Department of Pediatric Hematology-oncology, Assistance Publique des Hôpitaux de Paris Hôpital Trousseau, Paris, France.
⁵ Department of Pediatrics and Infectious Diseases, Assistance Publique des Hôpitaux de Paris Hôpital Robert Debré, Paris, France.
⁶ Université de Paris, Institut national de la santé et de la recherche médicale, U1123, Paris, France.
⁷ Department of Gynécology-Obstetrics, Assistance Publique des Hôpitaux de Paris Hôpital Trousseau, Paris, France.
⁸ Department of Gynecology and Obstetrics, Assistance Publique des Hôpitaux de Paris, Maternité Port Royal, Paris, France.
⁹ Department of Infectious and Tropical Diseases, Assistance Publique des Hôpitaux de Paris, Nord, Hôpital Bichat - Claude Bernard, Paris, France.
¹⁰ Department of infectious diseases, Centre Hospitalier inter-communal de Créteil, Créteil, France.
¹¹ Department of Clinical Microbiology, Assistance Publique des Hôpitaux de Paris Hôpital Necker-Enfants Malades, Université de Paris, Paris, France.
¹² Institut national de la santé et de la recherche médicale U1016, Centre national de la recherche scientifique UMR8104, Institut Cochin, Paris, France.
¹³ EHU 7328 PACT, Institut Imagine, Université de Paris, Paris, France.
¹⁴ Department of Epidemiology and Public Health, Assistance Publique des Hôpitaux de Paris Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
¹⁵ Université Paris-Saclay, Institut national de la santé et de la recherche médicale Centre d'Epidémiologie et de Santé des Populations U1018, Le Kremlin-Bicêtre, France.
¹⁶ Department of Infectious and Tropical Diseases, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France.
¹⁷ Institut national de la santé et de la recherche médicale, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.

PMID: 36037040
DOI: 10.1093/cid/ciac703

Abstract

Background: Antiretroviral therapy (ART) is remarkably effective in preventing perinatal transmission (PT) of HIV-1. We evaluated the PT rate in a population of women with widespread access to ART before conception.

Methods: The analysis included 14 630 women with HIV-1 who delivered from 2000 to 2017 at centers participating in the nationwide prospective multicenter French Perinatal Cohort (ANRS-EPF). PT was analyzed according to time period, timing of ART initiation, maternal plasma viral load (pVL), and gestational age at birth. No infants were breastfed, and all received neonatal prophylaxis.

Results: PT decreased between 3 periods, from 1.1% in 2000-2005 (58/5123) to 0.7% in 2006-2010 (30/4600) and to 0.2% in 2011-2017 (10/4907; P < .001). Restriction of the analysis to the 6316/14 630 (43%) women on ART at conception, PT decreased from 0.42% (6/1434) in 2000-2005 to 0.03% (1/3117) in 2011-2017 (P = .007). Among women treated at conception, if maternal pVL was undetectable near delivery, no PT was observed regardless of the ART combination [95%CI 0-0.07] (0/5482). Among women who started ART during pregnancy and with undetectable pVL near delivery, PT was 0.57% [95%CI 0.37-0.83] (26/4596). Among women treated at conception but with a detectable pVL near delivery, PT was 1.08% [95%CI 0.49-2.04] (9/834). We also qualitatively described 10 cases of transmission that occurred during the 2011-2017 period.

Conclusions: In a setting with free access to ART, monthly pVL assessment, infant ART prophylaxis, and in the absence of breastfeeding, suppressive ART initiated before pregnancy and continued throughout pregnancy can reduce PT of HIV to almost zero.

Keywords: HIV-1 perinatal transmission; antiretroviral therapy; plasma viral load monitoring; pregnancy; prevention of perinatal transmission.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Anti-HIV Agents* / therapeutic use
Anti-Retroviral Agents / therapeutic use
Female
France / epidemiology
HIV Infections* / drug therapy
HIV Infections* / epidemiology
HIV Infections* / prevention & control
HIV Seropositivity* / drug therapy
HIV-1*
Humans
Infant, Newborn
Infectious Disease Transmission, Vertical / prevention & control
Male
Pregnancy
Pregnancy Complications, Infectious* / drug therapy
Pregnancy Complications, Infectious* / prevention & control
Prospective Studies
Viral Load

Substances

Anti-HIV Agents
Anti-Retroviral Agents