Prevalence and pregnancy outcome of a persistently negative hiv-l high risk population

Abstract AR

Objectives : (1) To determine whether in highly HIV-1 exposed populations (commercial sex workers), some individuals are resistant to HIV infection.

(2) To determine the obstetric outcome in persistently HIV-1 sero¬negative pregnant commercial sex workers (prostitutes).

Study Design : 523 initially HIV-1 sero-negative prostitutes in Manipur, India, were studied between 1990 and 1999.

240 (46%) women sero-converted to HIV-1 during the study period.

HIV-1 PCR was done on 98 persistently sero-negative sex workers, who remained sero-negative after three years of follow-up.

Fifty-four of these women became pregnant (study group).

The course and outcome of pregnancy was studied prospectively in 54 persistently HIV-1 sero-negative commercial sex workers and compared with matched 58 HIV-1 sero-negative women, from the general population, coming for routine antenatal check-up.

Result ; The incidence of HIV-1 sero-conversion decreased with increasing duration of exposure.

Each weighted year of exposure through prostitution resulted in a 1.1 fold reduction in HIV-1 sero-conversion.

Persistent sero-negativity could not be explained by sero-negative HIV-1 infection or by differences in risk factors for HIV-1 infection.

Of the 54 sero-negative women (study group) who got pregnant, there were 52 singleton term vaginal deliveries and two emergency caesarian sections for fetal distress.

All 54 infants had negative viral cultures for HIV-1 at birth.

The women remained sero-negative throughout pregnancy, as did the control group.

All 54 infants were breast-fed and remained well.

Conclusion : A small proportion of highly exposed individuals may have a natural protective immunity to HTV, are resistant to HIV-1, and have a successful pregnancy outcome -