5A 4 Prevalence of Chlamydia and Gonorrhea in HIV-Infected Pregnant Women in the Americas

Thursday, June 12, 2014: 8:30 AM
Dogwood B
Kristina Adachi, MD1, Claire C Bristow, MSc2, Karin Nielsen-Saines, MD MPH1, Bonnie Ank, BA1, Mariza G Morgado, PhD3, D. Heather Watts, MD4, Fred Weir, PhD5, Lynne M Mofenson, MD4, Valdilea G Veloso, MD6 and Jeffrey Klausner, MD, MPH7, 1David Geffen School of Medicine, Department of Pediatrics, Division of Infectious Diseases, UCLA, Los Angeles, CA, 2Program in Global Health, UCLA, Los Angeles, CA, 3Laboratório de AIDS & Imunologia Molecular Instituto Oswaldo Cruz, Fundacao Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil, 4Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 5Research and Development, Cepheid, Sunnyvale, CA, 6Fundacao Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil, 7Division of Infectious Diseases and Program in Global Health, David Geffen School of Medicine and Fielding School of Public Health, Los Angeles, CA


Untreated sexually transmitted infections (STIs) in pregnancy such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) can have adverse effects on maternal and infant health.  Recent availability of highly sensitive nucleic acid amplification tests (NAAT) allow for more accurate prevalence assessments.  As part of NICHD HPTN 040, a multi-center clinical trial evaluating new infant treatment regimens for the prevention of intrapartum HIV mother-to-child transmission (MTCT), we evaluated the prevalence of these STIs and their association with HIV MTCT for the Americas cohort, which included Brazil, Argentina, and the U.S.  


Urine samples from 799 HIV-positive pregnant women collected at the time of labor/delivery underwent CT and NG NAAT using GeneXpert® (Cepheid Inc., Sunnyvale, CA).  Infant HIV infection was determined by HIV DNA PCR.  Infants were not breastfed. Descriptive statistics were used to summarize results, and Fisher’s exact test was used to compare HIV MTCT between groups.


Of the 799 HIV-positive pregnant women, 146 (18.3%) had infections with either CT, NG, or both CT/NG.  134 women (16.8%) had CT alone or in combination, 24 (3.0%) had NG either alone or in combination, and 12  women (1.5%) had dual CT/NG infection.  67 women (8.4%) transmitted HIV to their infants.  HIV MTCT in the CT-only group was 12.3% (15/122), 0% in the NG-only group (0/12), 25% (3/12) in the dual CT/NG group, and 7.5% (49/653) in the uninfected group (p <.001).  Women co-infected with CT/NG were 3.1 times as likely to transmit HIV to their infants (RR: 3.1; 95% CI: 1.1, 8.4) than those without these infections.  


HIV-positive pregnant women are at high risk for infection with CT and/or NG, which may impact HIV MTCT.  NAATs may facilitate effective CT and NG diagnosis and should be routinely implemented for active screening and treatment.