No Perinatal HIV-1 Transmission From Women With Effective Antiretroviral Therapy Starting Before Conception
Authors: Mandelbrot Laurent , Tubiana Roland , Le Chenadec Jerome , Dollfus Catherine , Faye Albert , Pannier Emmanuelle , Matheron Sophie , Khuong Marie-Aude , Garrait Valerie , Reliquet Veronique , Devidas Alain , Berrebi Alain , Allisy Christine , Elleau Christophe , Arvieux Cedric , Rouzioux Christine , Warszawski Josiane , Blanche Stéphane ,   for the ANRS-EPF Study Group, Mandelbrot Laurent , Crenn-Hebert Catherine , Floch-Tudal Corinne , Mazy Fabienne , Joras Marine , Meier Françoise , Mortier Emmanuel , Ceccaldi Pierre-François , Banige Maïa , Uludag Agnès Villemant , Zarouk Virginie , Lefort Agnès , Hittinger Gilles , Chamouilli Jean-Marc , Burle Christian , Lafeuillade Alain , Medus Marie , Bachelard Germaine , Dendale-Nguyen Joëlle , Guimard Thomas , Guimard Karine , Brossier Jean-Pierre , Perré Philippe , Esnault Jean-Luc , Stragier Olivier Bollengier , Leautez-Nainville Sophie , Martha Sandrine-Anne , Martha Benoît , Maurel Elise , Françoise Michel , Barat Muriel , Murger Patricia , Rouha Mahfoud , Lumbroso Philippe , Checoury Alain , Perfezou Pascale , Blondin Gilles , Ansart Séverine , De Saint Martin Luc , Le Moine Philippe , Daniel Corinne , Calvez Christian , Boutard Emmanuelle , Arvieux Cédric , Bauville Estelle , Dupre Christelle , Poinsignon Yves , Grelier Anne , Mousset Gaetane , Cudeville Corinne , Niault Mathilde , Belzic Isabelle , Moreau Philippe , Le Coz Marie-Françoise , Vaillant Odile Luycx , Vitrat Virginie , Tardif Didier , Gaillat Jacques , Vanderbergh Anne , Braig Suzanne , Dehlinger-Paul Marion , Mohamed Khaled , Heller-Roussin Brigitte , Winter Cécile , Firtion Ghislaine , Pannier Emmanuelle , Costa Myriam , Launay Odile , Ceron Dominique Salmon , Matheron Sophie , Rajguru Mandovi , Elaoun Neila , Allal Lahcene , Azria Elie , Moine Agnès Bourgeois , Garrait Valérie , Hau Isabelle , Touboul Claudine , Ratsimbazafy Lanto , Kommé Christiane , Elharrar Brigitte , Labaune Jean-Marc , Cotte Laurent , Rudigoz René-Charles , Elleau Christophe , Runel-Belliard Camille , Pistone Thierry , Muanza Blandine , Broustal Elisabeth , Duval-Arnould Marc , Carpentier Bénédicte , Dienga Etienne , Partisani MariaLuisa , Entz-Werle Natacha , David Eric , Rey David , Seaume Hervé , Ducrocq Sarah , Bailly-Salin Philippe , Tricoire Joëlle , Berrebi Alain , Cayla Claudine , Chacé Anne , Metheron Isabelle , Boutemy Anne , Armangaud Didier , Couderc Sophie , Routier Corinne , Alissa Alain , Questiaux Elisabeth , Zakaria Ahmed , Dauphin Hélène , Goissen Céline , Belloy Marie , Delassus Jean-Luc , Partisani MariaLuisa , Cheneau Christine , Lang Jean-Marie , Brault Dominique , Allisy Christine , Lebrette Marie-Gisèle , Selleret Lise , Hervé François , Bolot Pascal , Khuong-Josses Marie-Aude , Ekoukou Dieudoné , Bounan Stéphane , Blanche Stéphane , Lemercier Delphine , Frange Pierre , Veber Florence , Fisher Alain , Granier Michèle , Devidas Alain , Nguyen Rose , May Adrien , Chabrol Amélie , Chevojon Pierre , Moussa Zaitoun Abdallah , Pluchart Claire , Rouger Christine , Tubiana Roland , Bonmarchand Manuela , Shneider Luminata , Caby Fabienne , Calin Ruxandra-Oana , Coursol Anne , Chambrin Véronique , Labrune Philippe , Clech Laure , Pauly-Ravelly Isolde , Moalim Raghad , Sanchez Lydie , Johnson Ama , Lachassine Eric , Benoist Laurence , Jeantils Vincent , Gaudelus Joel , Benbara Amélie , Borgne Anne , Karaoui Leïla , Elbert Véronique Lefevre , Bongain André , Monpoux Fabrice , Deville Anne , Galiba Eliane , Doumet Antoine , Schmidt Jean-Luc , Cravello Ludovic , Hubert Claire , Dollfus Catherine , Hervé François , Tabone Marie-Dominique , Courcoux Mary-France , Leverger Guy , Carbonne Bruno , Pinquier Didier , Clavier Brigitte , Pinto-Cardoso Gaelle , Faye Albert , Matheron Sophie , Levine Martine , Marouts Erianna Bellaton , Borie Constance , Boissinot Christine , Peretti Delphine , Fourcade Corinne , Chirouze Catherine , Mauvais Cécile Hafner , Reliquet Véronique , Brunet-Cartier Cécile , Winer Norbert , Vaucel Edouard , Briandet Claire , Brouard Jacques , Demersay Arnaud Chalvon , Hentgen Véronique , Messaoudi Fabienne , Bernard Louis , Maakroun Zoha , Nau Pascale , Kebaïli Kamila , Billiemaz Kareen , Abrudan Ramona , Fialaire Pascale , Sentilhes Loïc , Proust Stéphanie , Arsac Philippe , Mesnard Louis , Werner Evelyne , Ciraru-Vigneron Nicole , Mouchnino Geneviève , Ayral Dominique , Vintejoux Emmanuelle , Lalande Muriel , Reynes Jacques , Segondy Michel , De Gennes Christiane , Clavel Cyril , Mazingue Françoise , Hammou Yamina , Ajana Faïza , Hatchuel Yves , Nahri Imad , Genet Claire , Ducroix-Roubert Sophie , Aubrard Yves , Constanty Anne , Weinbreck Pierre , Piet Emilie , Jacquier Françoise , Michau Christophe , Safwan Hassan , Boutet Arnaud , Abdelhadi Mohamed , Elenga Narcisse , Blanche Stéphane , Delmas Sandrine , Dollfus Catherine , Faye Albert , Frange Pierre , Le Chenadec Jérôme , Mandelbrot Laurent , Perilhou Anais , Rouzioux Christine , Sibiude Jeanne , Tubiana Roland , Warszawski Josiane 
Published: July 2015

Background.  The efficacy of preventing perinatal transmission (PT) of human immunodeficiency virus type 1 (HIV-1) depends on both viral load (VL) and treatment duration. The objective of this study was to determine whether initiating highly active antiretroviral therapy (ART) before conception has the potential to eliminate PT.

Methods.  A total of 8075 HIV-infected mother/infant pairs included from 2000 to 2011 in the national prospective multicenter French Perinatal Cohort (ANRS-EPF) received ART, delivered live-born children with determined HIV infection status, and did not breastfeed. PT was analyzed according to maternal VL at delivery and timing of ART initiation.

Results.  The overall rate of PT was 0.7% (56 of 8075). No transmission occurred among 2651 infants born to women who were receiving ART before conception, continued ART throughout the pregnancy, and delivered with a plasma VL &lt;50 copies/mL (upper 95% confidence interval [CI], 0.1%). VL and timing of ART initiation were independently associated with PT in logistic regression. Regardless of VL, the PT rate increased from 0.2% (6 of 3505) for women starting ART before conception to 0.4% (3 of 709), 0.9% (24 of 2810), and 2.2% (23 of 1051) for those starting during the first, second, or third trimester (P &lt; .001). Regardless of when ART was initiated, the PT rate was higher for women with VLs of 50–400 copies/mL near delivery than for those with &lt;50 copies/mL (adjusted odds ratio, 4.0; 95% CI, 1.9–8.2).

Conclusions.  Perinatal HIV-1 transmission is virtually zero in mothers who start ART before conception and maintain suppression of plasma VL.