Association of Maternal Viral Load and CD4 Count with Perinatal HIV-1 Transmission Risk during Breastfeeding in the PROMISE Postpartum Component

Patricia M. Flynn, Taha E. Taha, Mae Cababasay, Kevin Butler, Mary G. Fowler, Lynne M. Mofenson, Maxensia Owor, Susan Fiscus, Lynda Stranix-Chibanda, Anna Coutsoudis, Devasena Gnanashanmugam, Nahida Chakhtoura, Katie McCarthy, Lisa Frenkel, Ingrid Beck, Cornelius Mukuzunga, Bonus Makanani, Dhayendre Moodley, Teacler Nematadzira, Bangani KusakaraSandesh Patil, Tichaona Vhembo, Raziya Bobat, Blandina T. Mmbaga, Maysseb Masenya, Mandisa Nyati, Gerhard Theron, Helen Mulenga, David E. Shapiro

Research output: Contribution to journalArticlepeer-review

Abstract

Background:Breastfeeding mothers with HIV infection not qualifying for antiretroviral therapy (ART) based on country-specific guidelines at the time of the Promoting Maternal-Infant Survival Everywhere trial and their uninfected neonates were randomized to maternal ART (mART) or infant nevirapine prophylaxis (iNVP) postpartum. HIV transmission proportions were similar (<1%) in the 2 arms. We assessed whether maternal viral load (MVL) and CD4 cell counts were associated with breastfeeding HIV transmission.Methods:MVL was collected at entry (7-14 days postpartum) and at weeks 6, 14, 26, and 50 postpartum. CD4 cell counts were collected at entry and weeks 14, 26, 38, and 50 postpartum. Infant HIV-1 nucleic acid test was performed at weeks 1 and 6, every 4 weeks until week 26, and then every 12 weeks. The associations of baseline and time-varying MVL and CD4 cell counts with transmission risk were assessed using time-To-event analyses by randomized treatment arm.Results:Two thousand four hundred thirty-one mother-infant pairs were enrolled in the study. Baseline MVL (P = 0.11) and CD4 cell counts (P = 0.51) were not significantly associated with infant HIV-1 infection. Time-varying MVL was significantly associated with infant HIV-1 infection {hazard ratio [95% confidence interval (CI)]: 13.96 (3.12 to 62.45)} in the mART arm but not in the iNVP arm [hazard ratio (95% CI): 1.04 (0.20 to 5.39)]. Time-varying CD4 cell counts were also significantly associated with infant HIV-1 infection [hazard ratio (95% CI): 0.18 (0.03 to 0.93)] in the mART arm but not in the iNVP arm [hazard ratio (95% CI): 0.38 (0.08 to 1.77)].Conclusions:In women receiving mART, increased MVL and decreased CD4 cell counts during breastfeeding were associated with increased risk of infant HIV-1 infection.

Original languageEnglish (US)
Pages (from-to)206-213
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume88
Issue number2
DOIs
StatePublished - Oct 1 2021

Keywords

  • HIV transmission
  • perinatal HIV
  • peripartum transmission

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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