Maternal and perinatal factors related to maternal-infant transmission of HIV-1 in the (PC2)-C-2 HIV study: The role of EBV shedding

The association of maternal and perinatal factors with mother-infant transm ission of HIV-1 was examined in a prospective multicenter cohort of singlet on Live births to 508 HIV-1-infected women with children of known HIV-1 inf ection status (91 [18%] HIV-1-infected, 417 [82%] uninfected). From multiva riate logistic regression, independent predictors of HIV-1 transmission inc luded maternal CD4 percentage (CD4%) (odds ratio [OR] per 10% increase in C D4% = 0.70; p =.003), ruptured membranes <24 hours (OR = 3.15; p =.02), and maternal bleeding (OR = 2.90; p =.03), whereas maternal zidovudine (ZDV) u se was marginally associated (OR = 0.60; p =.08). The associations of mater nal urinary cytomegalovirus (CMV) shedding, oropharyngeal Epstein-Barr viru s (EBV) shedding, and serology profiles during pregnancy with HIV-1 transmi ssion were examined in the subset of mothers in whom the CMV and EBV measur ements were available. Maternal EBV seropositivity, CMV shedding, and CMV s eropositivity were 100% (279 of 279), 7% (16 of 229), and 92% (270 of 274), respectively. These rates did not differ between transmitting and nontrans mitting mothers. In univariate analyses, maternal EBV shedding was higher a mong transmitting than nontransmitting mothers (40 of 49 [82%] compared wit h 154 of 226 [68%]; p =.06) and was independently associated with transmiss ion in multivariate logistic analyses adjusting for CD4%, ruptured membrane s, and ZDV use, with an OR of 2.45 (95% confidence interval (CI), 1.03-5.84 ; p =.04). This permits the conclusion that EBV shedding is associated with maternal-infant HIV-1 transmission, independent of CD4%.