Antiretroviral Prophylaxis to Prevent Perinatal HIV Transmission in St. Petersburg, Russia: Too Little, Too Late

The researchers evaluated the type and timing of prophylaxis on mother-to-child HIV transmission in St. Petersburg, Russia. The authors used surveillance data for 1,498 HIV-infected women who delivered between 2004 and 2007, linked with polymerase chain reaction data for 1,159 infants, to determine predictors of perinatal infection.

Of the 1,159 infants, 73 became HIV-infected (6.3 percent, 95 percent confidence interval (CI) 4.9 percent to 7.7 percent). Among the 149 (12.8 percent) mother-infant pairs who received a full course of ante-, intra- and post-partum dual/triple antiretroviral prophylaxis, the transmission rate was 2.7 percent.

Among the 1,010 who received less complete regimens (full course zidovudine, single-dose nevirapine or incomplete), HIV transmission ranged from 4.1 percent to 12.2 percent. Among the 330 mothers (28.9 percent) who initiated ARVs <=20 weeks gestation, perinatal transmission was 1.8 percent, compared with 4.0 percent, 8.6 percent and 11.3 percent for those beginning at 21-28 weeks, 29-42 weeks or during labor and delivery, respectively (P for trend <0.0001).

Compared with those who began prophylaxis by 20 weeks or earlier, those initiating ARVs at 29 weeks or later (or not at all) had increased transmission odds (adjusted odds ratio: 4.9, 95 percent CI: 1.8-12.9; odds ratio: 5.1, 95 percent CI: 2.0-13.1, respectively), the team found.

"In St. Petersburg, the potential for further reductions in perinatal transmission is evident, given low transmission among women receiving early combination prophylaxis," the authors concluded.

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