Vertical transmission of toxoplasma by human immunodeficiency virus–infected women☆,☆☆,★,★★

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Abstract

OBJECTIVE: Our goal was to determine the frequency of mother-to-child transmission of Toxoplasma gondii from human immunodeficiency virus–infected mothers who are also chronically infected with T. gondii.

STUDY DESIGN: One hundred thirty-eight women were entered into a prospective study of human immunodeficiency virus infection in pregnancy. The women were seen at enrollment, during the third, sixth, and eighth months of pregnancy (except those enrolled later in pregnancy or at delivery), at 2 and 6 months post partum, and at 6-month intervals thereafter through 4 years after delivery. Standardized interviews and physical examinations were performed, and blood was drawn at each visit. Toxoplasma serologic testing was performed on the sample drawn earliest in pregnancy; the Sabin-Feldman dye test for immunoglobulin G antibodies and enzyme-linked immunoassays for immunoglobulins M, A, and E were used. Univariate analysis for categoric variables was performed with χ2and two-tailed Fisher exact tests, and for continuous variables the Student t test was used. Statistical Analysis System procedures were followed.

RESULTS: Twenty-eight of 138 (20.2%) women who had positive test results for human immunodeficiency virus had positive findings of the Sabin-Feldman dye test. Serologic status for T. gondii did not correlate with age, immune status, parity, or drug use. One of 27 children born to women who were seropositive for both human immunodeficiency virus and T. gondii (one child's serologic status for T. gondii was unknown) had Sabin-Feldman dye test antibodies beyond age 6 months (3.7%, 95% confidence interval 0.09% to 18.9%). Among the cohort of human immunodeficiency virus–infected mothers the rate of mother-to-child human immunodeficiency virus transmission did not vary with maternal Toxoplasma status. However, with sample sizes of 28 and 110, respectively, for the mothers who were T. gondii seropositive and seronegative, the power to detect a difference in the human immunodeficiency virus transmission rate between these groups would be relatively small.

CONCLUSIONS: Transmission of T. gondii from a chronically infected mother can occur in the setting of a human immunodeficiency virus infection, but this is not a common phenomenon. In a small cohort of human immunodeficiency virus–infected women we did not observe its occurrence among those without severe immunocompromise.(Am J Obstet Gynecol 1997;167:555-9.)

Section snippets

Material and methods

The Mothers and Infants Cohort Study enrolled pregnant women from obstetric clinics at the State University of New York–Brooklyn, Bronx Lebanon, and Albert Einstein Medical College in New York between January 1986 and January 1991. This report focuses on HIV-1 infected women whose deliveries occurred in Brooklyn. Details of recruitment are reported elsewhere.7

The women were seen at enrollment, during the third, sixth, and eighth months of pregnancy (except those enrolled later in pregnancy or

Results

Twenty-eight of 138 (20.2%) HIV-positive women had positive results of the Sabin-Feldman dye test (Table I). Serologic status for T. gondii did not correlate with age, immune status, parity, or history of drug use. Black women were significantly more likely than other ethnic groups to be positive for antibodies to T. gondii (24% vs 9%, p = 0.046); this was also true for nonsmokers versus smokers (24% vs 11%, p = 0.028). None of the women had detectable IgM antibodies to T. gondii. Three women

Comment

We have found, among 27 HIV-infected women with chronic T. gondii infection, that perinatal transmission of T. gondii occurred once. Although this represents a transmission rate of 3.7% for women dually infected with HIV and T. gondii, among mothers at greatest risk for central nervous system toxoplasmosis (CD4+ count <100 cells/mm3 and not receiving prophylaxis22) the transmission rate was one out of three. Overall, the rate of congenital toxoplasmosis in the HIV-infected maternal cohort was 1

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    • Cited by (0)

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    From the Departments of Obstetrics and Gynecologya and Internal Medicine,b State University of New York Health Science Center at Brooklyn, the Department of Immunology and Infectious Diseases, Palo Alto Medical Foundation and Stanford University School of Medicine,c and Westat Inc.d

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    Supported by grant RO-1-HD-25714 and contract NO-1-HD-82913 from the National Institute of Child Health and Human Development and contract NO-1-CP-61013 from the National Cancer Institute, Bethesda, Maryland.

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    Reprint requests: Howard Minkoff, MD, SUNY Health Science Center at Brooklyn, 450 Clarkson Ave., Box 24, Brooklyn, NY 11203.

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    0002-9378/97 $5.00 + 0 6/6/79058

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