Kristina Adachi1, Jeffrey D Klausner, Jiahong Xu, Bonnie Ank, Claire C Bristow, Mariza G Morgado, D Heather Watts, Fred Weir, David Persing, 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, Francisco I Bastos, George Siberry, Karin Nielsen-Saines. 1. From the *David Geffen UCLA School of Medicine, Los Angeles, California; †UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles, California; ‡Westat, Rockville, Maryland; §Fundacao Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil; ¶Office of the Global AIDS Coordinator, US Department of State, Washington DC; ‖Cepheid, Sunnyvale, California; **Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; ††Hospital Geral de Nova Iguaçu, DST/AIDS, Nova Iguaçu, Rio de Janeiro, Brazil; ‡‡Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil; §§SAMRC and Perinatal HIV Research Unit, University of Witwatersrand, Cape Town, South Africa; ¶¶Department of Obstetrics and Gynecology, Stellenbosch University/Tygerberg Hospital, Cape Town, South Africa; ‖‖Serviço de Infectologia, Hospital Conceicao, Porto Alegre, Rio Grande do Sul, Brazil; ***Hospital Femina, Porto Alegre, Rio Grande do Sul, Brazil; †††Irmandade da Santa Casa de Misericordia de Porto Alegre, Rio Grande do Sul, Brazil; ‡‡‡Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; §§§Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil; ¶¶¶Foundation for Maternal and Infant Health (FUNDASAMIN), Buenos Aires, Argentina; and ‖‖‖Escola Paulista de Medicina-Universidade Federal de São Paulo, São Paulo, Brazil.
Abstract
BACKGROUND: Sexually transmitted infections (STIs) in pregnancy such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) may lead to adverse infant outcomes. METHODS: Individual urine specimens from HIV-infected pregnant women diagnosed with HIV during labor were collected at the time of infant birth and tested by polymerase chain reaction for CT and NG. Infant HIV infection was determined at 3 months with morbidity/mortality assessed through 6 months. RESULTS: Of 1373 maternal urine samples, 277 (20.2%) were positive for CT and/or NG; 249 (18.1%) for CT, 63 (4.6%) for NG and 35 (2.5%) for both CT and NG. HIV infection was diagnosed in 117 (8.5%) infants. Highest rates of adverse outcomes (sepsis, pneumonia, congenital syphilis, septic arthritis, conjunctivitis, low birth weight, preterm delivery and death) were noted in infants of women with CT and NG (23/35, 65.7%) compared with NG (16/28, 57.1%), CT (84/214, 39.3%) and no STI (405/1096, 37%, P = 0.001). Death (11.4% vs. 3%, P = 0.02), low birth weight (42.9% vs. 16.9%, P = 0.001) and preterm delivery (28.6% vs. 10.2%, P = 0.008) were higher among infants of CT and NG-coinfected women. Infants who had any adverse outcome and were born to women with CT and/or NG were 3.5 times more likely to be HIV infected after controlling for maternal syphilis (odds ratio: 3.5, 95% confidence interval: 1.4-8.3). By adjusted multivariate logistic regression, infants born to mothers with any CT and/or NG were 1.35 times more likely to have an adverse outcome (odds ratio, 1.35; 95% confidence interval, 1.03-1.76). CONCLUSIONS: STIs in HIV-infected pregnant women are associated with adverse outcomes in HIV-exposed infected and uninfected infants.
BACKGROUND: Sexually transmitted infections (STIs) in pregnancy such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) may lead to adverse infant outcomes. METHODS: Individual urine specimens from HIV-infected pregnant women diagnosed with HIV during labor were collected at the time of infant birth and tested by polymerase chain reaction for CT and NG. InfantHIV infection was determined at 3 months with morbidity/mortality assessed through 6 months. RESULTS: Of 1373 maternal urine samples, 277 (20.2%) were positive for CT and/or NG; 249 (18.1%) for CT, 63 (4.6%) for NG and 35 (2.5%) for both CT and NG. HIV infection was diagnosed in 117 (8.5%) infants. Highest rates of adverse outcomes (sepsis, pneumonia, congenital syphilis, septic arthritis, conjunctivitis, low birth weight, preterm delivery and death) were noted in infants of women with CT and NG (23/35, 65.7%) compared with NG (16/28, 57.1%), CT (84/214, 39.3%) and no STI (405/1096, 37%, P = 0.001). Death (11.4% vs. 3%, P = 0.02), low birth weight (42.9% vs. 16.9%, P = 0.001) and preterm delivery (28.6% vs. 10.2%, P = 0.008) were higher among infants of CT and NG-coinfected women. Infants who had any adverse outcome and were born to women with CT and/or NG were 3.5 times more likely to be HIV infected after controlling for maternal syphilis (odds ratio: 3.5, 95% confidence interval: 1.4-8.3). By adjusted multivariate logistic regression, infants born to mothers with any CT and/or NG were 1.35 times more likely to have an adverse outcome (odds ratio, 1.35; 95% confidence interval, 1.03-1.76). CONCLUSIONS: STIs in HIV-infected pregnant women are associated with adverse outcomes in HIV-exposed infected and uninfected infants.
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