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Twin pregnancy as a risk factor for mother-to-child transmission of HIV-1: trends over 20 years

Scavalli, Claudia Palladino Silia,b; Mandelbrot, Laurenta,c; Berrebi, Alaind; Batallan, Agnèse; Cravello, Ludovicf; Pannier, Emmanuelleg; Hamrene, Karimaa; Ciraru-Vigneron, Nicoleh; Faye, Alberti; Warszawski, Josianea,j,k,l; ANRS EPF

doi: 10.1097/QAD.0b013e3281532b19
Epidemiology and Social

Objective: We investigated whether twin pregnancies were at increased risk of mother-to-child HIV-1 transmission (MTCT), in comparison with singletons.

Methods: Among HIV-1 infected women enrolled in the French Perinatal HIV Cohort (n = 9262), we studied the association between twin deliveries and MTCT rate according to three time periods (pre-1994, 1994–1996, 1997–2004) and the effect of birth order. The mother was considered to have transmitted if at least one of the twins was infected. Univariate and multivariate analyses of risk factors for MTCT were performed for deliveries in the periods up to 1996.

Results: Overall, 2.1% (192/9262) of all the deliveries were twins. The rate of prematurity was greater in twins than in singletons (54% and 13%, respectively). Up to 1996 the rate of MTCT of HIV-1 was 28.3% (15/53) in twin pregnancies, versus 13.5% (414/3077) in singletons [odds ratio (OR), 2.5; 95% confidence interval (CI), 1.4–4.7; P = 0.002; adjusted OR, 2.3: 95% CI, 1.1–2.3; P = 0.03). In the period from 1997 to 2003, MTCT was low and did not differ between twins (1.0%) and singletons (1.8%; P = 1.0). Overall, the transmission rate for the first-born child was threefold that for the second-born child (14/164, 8.5% versus 4/164, 2.4%; P = 0.008).

Conclusion: Twin pregnancies were at increased risk of transmission, but in the era of HAART this risk was reduced for twins, as well as singletons. Management of multiple pregnancies should take into account the risks of premature rupture of the membranes and preterm delivery.

From the aInserm, U822, IFR69, Le Kremlin-Bicêtre, France

bDipartimento di Epidemiologia, Istituto Nazionale per le Malattie Infettive ‘L. Spallanzani’ – IRCCS, Rome, Italy

cAPHP Hopital Louis Mourier, Service de Gynecologie-Obstetrique, Colombes and Universite Paris 7 Diderot, Paris

dCHU de Toulouse, Service de Gynecologie-Obstetrique, Toulouse, Paris

eAPHP Hopital Bichat, Service de Gynecologie-Obstetrique, Paris

fCHU de Marseille, Service de Gynecologie-Obstetrique, Marseille, Paris

gAPHP Hopital Cochin, Service de Gynecologie-Obstetrique, Paris

hAPHP Hopital Lariboisiere, Service de Gynecologie-Obstetrique, Paris

iAPHP Hopital Robert Debre, Service de Pediatrie, Paris

jINED, Paris

kUniversite Paris-Sud, Le Kremlin-Bicêtre, France

lAP-HP Hopital Bicêtre, Service de Santé Publique, Le Kremlin Bicêtre, France.

Received 20 December, 2006

Revised 27 February, 2007

Accepted 7 March, 2007

Correspondence to L. Mandelbrot, Universite Paris 7 Diderot, APHP Service de Gynecologie Obstetrique, Hopital Louis Mourier 178 rue des Renouillers, 92700 Colombes, France. Tel: +33 1 47 60 63 39; fax: +33 1 47 60 63 38; e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.