Risk factors for late postnatal transmission of human immunodeficiency virus type 1 in Sub-Saharan Africa

Charles Chasela, Ying Qing Chen, Susan Fiscus, Irving Hoffman, Alicia Young, Megan Valentine, Lynda Emel, Taha E. Taha, Robert L. Goldenberg, Jennifer S. Read

Research output: Contribution to journalArticlepeer-review

Abstract

Background: We conducted secondary data analyses of a clinical trial (HIVNET 024) to assess risk factors for late postnatal transmission (LPT) of human immunodeficiency virus type 1 (HIV-1) through breast-feeding. Methods: Data regarding live born, singleton infants of HIV-1-infected mothers were analyzed. The timing of HIV-1 transmission through 12 months after birth was defined as: in utero (positive HIV-1 RNA results at birth), perinatal/early postnatal (negative results at birth, positive at 4-6 week visit), or LPT (negative results through the 4-6 week visit, but positive assays thereafter through the 12-month visit). HIV-1-uninfected infants were those with negative HIV-1 enzyme immunoassay results at 12 months of age, or infants with negative HIV-1 RNA results throughout follow-up. Results: Of 2292 HIV-1-infected enrolled women, 2052 mother/infant pairs met inclusion criteria. Of 1979 infants with HIV-1 tests, 404 were HIV-1-infected, and 382 had known timing of infection (LPT represented 22% of transmissions). Further analyses of LPT included infants who were breast-feeding at the 4-6 week visit (with negative HIV-1 results at that visit) revealed 6.9% of 1317 infants acquired HIV-1 infection through LPT by 12 months of age. More advanced maternal HIV-1 disease at enrollment (lower CD4 counts, higher plasma viral loads) were the factors associated with LPT in adjusted analyses. Conclusions: In this breast-feeding population, 6.9% of infants uninfected at 6 weeks of age acquired HIV-1 infection by 12 months. Making interventions to decrease the risk of LPT of HIV-1 available and continuing research regarding the mechanisms of LPT (so as to develop improved interventions to reduce such transmission) remain essential.

Original languageEnglish (US)
Pages (from-to)251-256
Number of pages6
JournalPediatric Infectious Disease Journal
Volume27
Issue number3
DOIs
StatePublished - Mar 2008

Keywords

  • Breast-feeding
  • Mother-to-child transmission of HIV-1
  • Risk factors
  • Sub-Saharan Africa

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

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