Factors Associated with Mother‐to‐Child Transmission of HIV‐1 Despite a Maternal Viral Load <500 Copies/mL at Delivery: A Case‐Control Study Nested in the French Perinatal Cohort (EPF‐ANRS CO1)

Abstract

Background. The rate of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) type 1 is as low as 0.5% in non–breast-feeding mothers who delivered at term while receiving antiretroviral therapy with a plasma viral load + T cell count, and time at antiretroviral therapy initiation, viral load was the only factor independently associated with MTCT of HIV (adjusted odds ratio, 23.2; 95% confidence interval, 3.5–553; P<.001). Conclusions. Early and sustained control of viral load is associated with a decreasing residual risk of MTCT of HIV-1. Guidelines should take into account not only CD4⁺ T cell count and risk of preterm delivery, but also baseline HIV-1 load for deciding when to start antiretroviral therapy during pregnancy.