An assessment of the timing of mother-to-child transmission of human immunodeficiency virus type 1 by means of polymerase chain reaction.
To approximate the contributions of in utero, intrapartum, and postnatal transmission of human immunodeficiency virus type-1 (HIV-1) and to evaluate polymerase chain reaction (PCR) as a diagnostic tool for pediatric HIV infection, blood was collected at birth (cord blood), and at 3, 6-12, and 13-24 months in 218 children born to HIV-1-seropositive mothers in Kigali, Rwanda. Proviral DNA was detected by a double PCR using two sets of three primers (gag, pol, and env). Pediatric HIV-1 infection was defined according to serological and clinical criteria. The probability of having a positive PCR at a given time was calculated by a nonparametric method. Among children with unequivocal evidence of infection (n = 47), it was 30.5% on cord blood and 80.6% at 3 months. Thus, in children born to HIV-1-infected mothers, the estimated rate of transmission in the late postnatal period is 4.9%, and the rate of transmission in the intrapartum plus postnatal periods is 17.6%. Among 117 HIV-1-uninfected children born to HIV-1-infected mothers, six (5%) had a false-positive PCR on cord blood. These results should be taken into account in designing intervention trials aimed at reducing mother-to-child transmission of HIV-1.
Simonon
A
A
National AIDS Control Programme, AIDS Reference Laboratory, Kigali, Rwanda.
Lepage
P
P
Karita
E
E
Hitimana
D G
DG
Dabis
F
F
Msellati
P
P
Van Goethem
C
C
Nsengumuremyi
F
F
Bazubagira
A
A
Van de Perre
P
P
D001942:Breast Feeding; D015331:Cohort Studies; D016001:Confidence Intervals; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D005312:Fetal Blood / Q000382:microbiology; D005500:Follow-Up Studies; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000635:transmission*; D015497:HIV-1 / Q000235:genetics*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood; D011336:Probability; D011446:Prospective Studies; D012432:Rwanda; D013997:Time Factors
D004279:DNA, Viral; D015483:HIV Antibodies