Impact of HCV Coinfection on Mother-to-Child HIV Transmission

Past research has shown that HIV-HCV coinfected mothers are more likely to transmit hepatitis C virus (HCV) to their babies during pregnancy or delivery compared to women with HCV alone, but there is less data about the effect of coinfection on perinatal HIV transmission.

As presented at the 46th Interscience Conference on Antimicrobial Agents and Chemotherapy, taking place this week in San Francisco, Spanish researchers conducted a study to evaluate the impact of HIV-HCV coinfection on mother-to-child HIV transmission and pregnancy outcomes.

They prospectively evaluated all HIV positive pregnant women at a 900-bed hospital from January 1995 to December 2005. A total of 142 mother-infant pairs were included in the analysis. About half (52.1%) were on combination HAART, 10.5% were taking 2 antiretroviral drugs to treat HIV, 21.8% were taking AZT monotherapy to prevent perinatal transmission, and 22% were on no anti-HIV therapy. About two-thirds (61.3%) had vaginal deliveries and 38.7% had Caesarean sections.

Results

90 HIV positive women (63.4%) were coinfected with HCV, which was strongly related to illicit drug use.

The overall mother-to-child (fetus) HIV transmission rate was 4%.

The mother-to-child transmission rate for HCV was 4.4%.

In a univariate analysis, the following factors were associated with a higher risk of mother-to-child HIV transmission:

- no use of antiretroviral therapy during pregnancy;
- poor virological control during pregnancy;
- coinfection with HCV.

No HIV-infected infants were born to:

- HCV negative mothers;
- mothers treated with combination HAART;
- mothers who delivered by Caesarean section.

In a multivariate analysis, not being on antiretroviral therapy was the only independent predictor of mother-to-child HIV transmission (OR 0.41).

HIV-HCV coinfected mothers had greater risk of gestational cholestasis (bile blockage) than HCV negative women (OR 1.55).

Coinfected mothers had babies with lower birth weights (P < 0.05).

Conclusion

The researchers concluded that HIV-HCV coinfection was not independently related to maternal-fetal transmission of HIV. However, they added that coinfected pregnant women "presented less compliance with antiretroviral therapy and worse [HIV] control during pregnancy."

09/29/06

Reference
J Murillas, M Leyes, J Duenas, and others. Prevention of Maternal-Fetal Transmission of HIV-Infection in Spain. Impact of HCV-Coinfection From 1995 to 2005. 46th Interscience Conference on Antimicrobial Agents and Chemotherapy. San Francisco, CA. September 27-30, 2006. Abstract H-1889.

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