Acute and chronic chorioamnionitis and the risk of perinatal human immunodeficiency virus-1 transmission

• Published in: American journal of obstetrics and gynecology 2006, Vol.194 (1), p.174-181
• Main Authors: Chi, Benjamin H., Mudenda, Victor, Levy, Jens, Sinkala, Moses, Goldenberg, Robert L., Stringer, Jeffrey S.A.
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Anti-HIV Agents - therapeutic use; Biological and medical sciences; Chorioamnionitis; Chorioamnionitis - epidemiology; Chronic Disease; Delivery. Postpartum. Lactation; Diseases of mother, fetus and pregnancy; Disorders; Female; Fetal Blood; Gynecology. Andrology. Obstetrics; HIV Infections - blood; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - transmission; HIV-1; Human immunodeficiency virus-1; Humans; Infectious Disease Transmission, Vertical - prevention & control; Interleukin-6; Interleukin-6 - blood; Labor, Obstetric; Maternal-Fetal Exchange; Medical sciences; Mother-to-child human immunodeficiency virus-1 transmission; Nevirapine - therapeutic use; Perinatal human immunodeficiency virus-1 transmission; Predictive Value of Tests; Pregnancy; Pregnancy. Fetus. Placenta; Prevalence; Risk Assessment; Time Factors
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2005.06.081

This study was undertaken to examine the prevalence of acute and chronic chorioamnionitis among women infected with human immunodeficiency virus-1 (HIV-1) and to determine the relative contribution of each to perinatal HIV-1 transmission. In 227 HIV-infected women receiving intrapartum/neonatal nevirapine prophylaxis, we examined associations between fetal membrane histology, cord blood interleukin-6 (IL-6), and perinatal HIV-1 transmission. Acute chorioamnionitis was present in 122 of 227 specimens; chronic chorioamnionitis in 64 of 227. There was a positive correlation between acute chorioamnionitis and labor length ( r = 0.208; P = .002), time of ruptured membrane ( r = 0.177; P = .008), and cord IL-6 ( r = 0.390; P < .001). Chronic chorioamnionitis was associated with high viral load ( P = .05) and low cord IL-6 ( P < .001). Severe chronic chorioamnionitis was associated with intrauterine HIV-1 transmission (odds ratio [OR] = 7.61; 95% CI = 1.04-85.5), but no correlation was demonstrated between acute chorioamnionitis and vertical transmission. In a setting of high perinatal nevirapine use, acute chorioamnionitis was not associated with vertical HIV-1 transmission. Risk for intrauterine transmission increased significantly when chronic chorioamnionitis was present.