title: Postnatal transmission of human immunodeficiency virus type 1 from mother to infant. A prospective cohort study in Kigali, Rwanda.
abstract: BACKGROUND
  Although transmission of human immunodeficiency virus type 1 (HIV-1) from mother to infant has been well documented during pregnancy and delivery, little is known about the possible transmission of HIV-1 during the postnatal period.
  
  
  METHODS
  We conducted a prospective cohort study in Kigali, Rwanda, of 212 mother-infant pairs who were seronegative for HIV-1 at delivery. All the infants were breast-fed. The subjects were followed at three-month intervals, with Western blot assays for antibodies to HIV-1 and testing of mononuclear cells by a double polymerase chain reaction (PCR) using three sets of primers. To evaluate potential risk factors, each mother who seroconverted was matched with three seronegative control women.
  
  
  RESULTS
  After a mean follow-up of 16.6 months, 16 of the 212 mothers became seropositive for HIV-1. Of their 16 infants, 9 became seropositive. One infant was excluded from the analysis because of a positive test by PCR on the blood sample obtained at birth. Postnatal seroconversion to HIV-1 occurred in four of the five infants born to the mothers who seroconverted during the first 3 months post partum, and in four infants of the 10 mothers who seroconverted between month 4 and month 21. In all cases, the infant seroconverted during the same three-month period as the mother. The main risk factor for maternal seroconversion was being single.
  
  
  CONCLUSIONS
  HIV-1 infection can be transmitted from mothers to infants during the postnatal period. Colostrum and breast milk may be efficient routes for the transmission of HIV-1 from recently infected mothers to their infants.
authors.affiliation: AIDS Reference Laboratory, National AIDS Control Program, Kigali, Rwanda.
authors.forename: P
authors.initials: P
authors.lastname: Van de Perre
authors.forename: A
authors.initials: A
authors.lastname: Simonon
authors.forename: P
authors.initials: P
authors.lastname: Msellati
authors.forename: D G
authors.initials: DG
authors.lastname: Hitimana
authors.forename: D
authors.initials: D
authors.lastname: Vaira
authors.forename: A
authors.initials: A
authors.lastname: Bazubagira
authors.forename: C
authors.initials: C
authors.lastname: Van Goethem
authors.forename: A M
authors.initials: AM
authors.lastname: Stevens
authors.forename: E
authors.initials: E
authors.lastname: Karita
authors.forename: D
authors.initials: D
authors.lastname: Sondag-Thull
mesh_terms: D001483:Base Sequence; D015331:Cohort Studies; D003126:Colostrum / Q000382:microbiology; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D006679:HIV Seropositivity / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008393:Marriage; D008895:Milk, Human / Q000382:microbiology; D008969:Molecular Sequence Data; D009035:Mothers; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D012432:Rwanda