Maternal-to-Child-Transmission of Human Immunodeficiency Virus in Maternal Preterm Premature Rupture of the...

Preterm premature rupture of membranes (PPROM) in the context of maternal human immunodeficiency virus (HIV) infection poses a significant clinical dilemma, as clinicians must balance the risks of prematurity with the risks of delaying delivery and potentially increasing the chance of mother-to-child transmission (MTCT) of HIV. This review aimed to identify the rate of MTCT in HIV-positive pregnant individuals with PPROM and assess neonatal outcomes.

A systematic search strategy following PRISMA guidelines, developed by an information specialist, was applied across seven online databases from inception to 2023. Prospective and retrospective cohort studies of HIV-positive patients with PPROM in which rates of MTCT were reported were included. Case reports and case series were eligible for inclusion. Data were extracted by two independent reviewers, and meta-analysis was performed when possible.

Of 312 screened articles, three studies from the USA and one from South Africa met inclusion criteria, representing 58 pregnancies. The crude rate of MTCT was 6.9% (n = 4). Unadjusted logistic regression in two studies revealed no association between MTCT and antiretroviral use, CD4 count, gestational age, or length of PPROM. There was, however, a trend toward increased MTCT risk with elevated viral load (p = 0.09) or spontaneous vaginal delivery (p = 0.06).

The crude rate of MTCT of HIV in women with PPROM was approximately 6.9%, albeit in a heterogeneous population with variable antiretroviral use. More recent data reflecting contemporary HIV management are needed to better inform counseling and decision making in this challenging clinical scenario.