Maternal syphilis and vertical perinatal transmission of human immunodeficiency virus type-1 infection

Objectives: To identify risk factors for vertical HIV transmission that may provide opportunities for the prevention of future pediatric HIV infection . Study Design: A prospective cohort of 44 pregnant HIV(+) women and their 53 offspring was followed between July 1989 and July 1996. Results: Seconda ry and latent maternal syphilis infection was diagnosed in four pregnancies with VDRL titers greater than or equal to 1:128. Concurrent maternal syphi lis infection was associated with 100% vertical HIV transmission (4/4), com pared to 21% (3/14) deliveries that occurred in 13 women with only a histor y of treated sypillis (P = 0.01) and 14% (5/35) deliveries in women with no history of syphilis (P = 0.0015). Among non-Zidovudine exposed pregnancies , 100% (3/3) patients with concurrent syphilis transmitted HIV to their inf ants vs. 0% (0/8) patients with only a history of syphilis (P = 0.006). A h istory of treated syphilis did not increase subsequent transmission risk co mpared to women with no history of syphilis (3/14 vs. 5/35, P = 0.41). One patient delivered twice during the study and received Zidovudine prophylaxi s during both pregnancies. Her first pregnancy VDRL titer was greater than or equal to 1:128, during which she delivered an HIV infected child. Follow ing successful treatment for syphilis (VDRL titer, 1:I), she conceived agai n and delivered an uninfected infant 11 months later. Additional risk facto rs significantly associated with vertical HIV transmission were prematurity and low birth weight. Variables studied but not statistically-related to H IV transmission included: other sexually transmitted diseases, maternal age , race, intravenous drug or cocaine use, prenatal care, route of delivery, duration of HIV(+) status, and CD4 count. Conclusion: Among HIV(+) women, c oncurrent syphilis infection, but not a history of syphilis, is significant ly associated with vertical perinatal HIV transmission. Frequent screening and prompt treatment of syphilis in non-pregnant HN(+) women may help preve nt subsequent HIV infected pregnancies. (C) 1998 International Federation o f Gynecology and Obstetrics.