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

Georgette Adjorlolo-Johnson, MD; Kevin M. De Cock, MD, MRCP, DTM&H; Ehounou Ekpini, MD; Kathleen M. Vetter, MPH; Toussaint Sibailly, MD; Kari Brattegaard; Daniel Yavo; Ronan Doorly, MAI; J. Patrick Whitaker, MPH; Luc Kestens, PhD; Chin-Yih Ou, PhD; J. Richard George, PhD; Helene D. Gayle, MD, MPH
JAMA. 1994;272(6):462-466. doi:10.1001/jama.1994.03520060062033.
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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)


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