CESAREAN DELIVERIES AND MATERNAL-INFANT HIV TRANSMISSION - RESULTS FROM A PROSPECTIVE-STUDY IN SOUTH-AFRICA

Data from a prospective study undertaken at an urban hospital in Durba n, South Africa, were used to investigate associations between materna l-infant HIV transmission, mode of delivery, and specific circumstance s of cesarean deliveries. A total of 141 children of HIV-infected wome n were followed until the children were 15 months of age to determine their HIV status, Supplementary data were collected from obstetric rec ords, masked to the HIV status of the children. In this African and pr edominantly breast-fed population, infants delivered vaginally were mo re likely to be infected (39.8% infected) than were infants delivered by cesarean section [22.9% infected; odds ratio (OR), 0.45; 95% confid ence interval(CI), 0.20-0.99]. There were no significant differences b etween cesarean deliveries undertaken following prior rupture of membr anes and those undertaken with membranes intact, but numbers for this comparison were small, Singleton cesarean deliveries without concurren t obstetric complications had lower rates of transmission than did vag inal deliveries (OR, 0.20; 95% CI, 0.04-0.94). These results suggest t hat certain intrapartum events may modify the risk of HIV transmission and highlight the importance of collecting more detailed intrapartum information in order to clarify the route by which mode of delivery ma y be associated with maternal-infant HIV transmission.