Increased Risk for Infant HIV Transmission in Pregnant Women With STI Coinfection

Pregnant women with HIV have a high risk of contracting sexually transmitted infections (STIs), and the presence of STI coinfection is associated with an increased risk for HIV mother-to-child transmission, according to data published in PLoS ONE.

Kristina Adachi, MD, from the David Geffen University of California, Los Angeles, School of Medicine, and colleagues examined the role of combined maternal STIs in HIV mother-to-child transmission in 899 mother-infant pairs. The researchers tested urine samples from HIV-infected pregnant women for Chlamydia trachomatis, Neisseria gonorrhoeae, and cytomegalovirus. Serial HIV polymerase chain reaction was used to test for infant HIV infection, and maternal syphilis testing was performed with Venereal Disease Research Laboratory titers with confirmatory treponemal syphilis antibody tests.

The results showed that rates of STIs were highest among women between 13 and 24 years of age (35.6%). The researchers observed high rates of Treponema pallidum (8.7%), Chlamydia trachomatis (17.8%), Neisseria gonorrhoeae (4%), and cytomegalovirus (6.3%).

The overall rate of mother-to-child HIV transmission was 9.1%. In addition, mother-to-child transition was 12.5%, 10.3%, 11.1%, and 26.3% among infants born to women with Chlamydia trachomatis, Treponema pallidum, Neisseria gonorrhoeae, or cytomegalovirus, respectively. About 42% of HIV-infected infants were born to mothers with at least 1 of the 4 infections.

Women with an STI coinfection were almost twice as likely to have an HIV-infected infant (adjusted odds ratio [OR], 1.9; 95% CI, 1.1-3.0), especially women with 2 STIs (OR, 3.4; 95% CI, 1.5-7.7). Maternal cytomegalovirus (OR, 4.4; 95% CI, 1.5-13.0) and infant congenital cytomegalovirus (OR, 4.1; 95% CI, 2.2-7.8) were associated with an increased risk for mother-to-child HIV transmission.

The researchers note that although inclusion and exclusion populations were similar, there were some differences in maternal age, mode of delivery, prenatal care, alcohol use, tobacco use, and maternal HIV viral load. The current study did not include other STIs and genital tract infections, such as bacterial vaginosis, Trichomonas vaginalis, and Herpes simplex virus.

“Our data underscores the need to augment current existing antenatal care programs to include STI screening, particularly for high-risk women such as young, HIV-infected pregnant women as well as ensuring that HIV-infected women have consistent access to antiretroviral treatment and monitoring, particularly during pregnancy,” the authors concluded.

Reference

Adachi K, Xu J, Yeganeh N, et al. Combined evaluation of sexually transmitted infections in HIV-infected pregnant women and infant HIV transmission. PLoS ONE. 2018;13(1):e0189851.