Objective: To investigate whether mother-to-child transmission (MTCT) management and rate differed between African immigrants and French-born women delivering in France.
Methods: MTCT strategies were studied among human immunodeficiency virus type 1-infected women delivering between 1984 and 2007 in the multicenter French Perinatal Cohort, according to geographical origin.
Results: Among 9245 pregnancies (in 7090 women), the proportion of African mothers increased from 12% in 1984–1986 to 64% in 2003–2004. African women had later access to care than French women, even in recent years (1997–2004). They more often discovered their HIV infection during pregnancy (40.6 vs. 11.5%, P < 0.001), started prenatal care in the third trimester (14.1 vs. 9.8%, P < 0.001) and started antiretroviral therapy after 32 weeks gestation (7.6 vs. 4.1%, P < 0.001). The association with late treatment initiation disappeared when adjusted for late HIV diagnosis and prenatal care (adjusted odds ratio 1.0, 95% confidence interval 0.7–1.4). African and French women did not differ in terms of access to highly active antiretroviral therapy, nor for substandard management such as vaginal delivery with uncontrolled viral load, lack of intrapartum and postpartum treatment or breastfeeding. The MTCT rate was higher for African than for French women receiving antiretroviral therapy (1.8 vs. 0.8%, P = 0.02), but the difference was no longer significant after adjustment for main transmission risk factors (adjusted odds ratio = 1.7, 95% confidence interval 0.8–3.7, P = 0.17). MTCT did not differ among 2110 term deliveries with maternal viral load less than 400 copies/ml, (0.8 vs. 0.6%, P = 0.5).
Conclusion: African immigrants more often had late HIV screening in pregnancy than French-born women, but had similar access to MTCT prevention, once the infection was diagnosed.
aINSERM Unit 822, Le Kremlin-Bicêtre, Paris
bAP-HP, Hôpital Bicêtre, Epidemiology and Public Health Service, Le Kremlin-Bicêtre, Paris
cUniversité Paris 7, Paris
dAP-HP, Hôpital Louis Mourier, Gynecology and Obstetrics Department, Colombes, Paris
eAP-HP, Hôpital Pitié Salpêtrière, Department of Infectious Diseases, Paris
fINSERM Unit 720, Paris
hAP-HP, Hôpital Robert Debré, Service de Pédiatrie Générale, Paris
iAP-HP, Hôpital Trousseau, Service d'Hématologie et d'oncologie pédiatrique, Paris
jAP-HP, Necker Hospital, Virology Department, Paris
kEA 3620, Université Paris Descartes 5, Paris
lAP-HP, Necker Hospital, Unité d'Immunologie Hématologie Pédiatrique, Paris
mUniversité Paris-Sud 11, Faculté de Médecine Paris-Sud,Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
Received 21 November, 2007
Revised 13 April, 2008
Accepted 23 April, 2008
Correspondence to Josiane Warszawski, INSERM, INED U822, 82, rue du Général Leclerc, 94 276 Le Kremlin Bicêtre cedex, France. E-mail: email@example.com