Correlates of mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission: association with maternal plasma HIV-1 RNA load, genital HIV-1 DNA shedding, and breast infections.
To determine the effects of plasma, genital, and breast milk human immunodeficiency virus type 1 (HIV-1) and breast infections on perinatal HIV-1 transmission, a nested case-control study was conducted within a randomized clinical trial of breast-feeding and formula feeding among HIV-1-seropositive mothers in Nairobi, Kenya. In analyses comparing 92 infected infants with 187 infants who were uninfected at 2 years, maternal viral RNA levels >43,000 copies/mL (cohort median) were associated with a 4-fold increase in risk of transmission (95% confidence interval [CI], 2.2-7.2). Maternal cervical HIV-1 DNA (odds ratio [OR], 2.4; 95% CI, 1.3-4.4), vaginal HIV-1 DNA (OR, 2.3; 95% CI, 1.1-4.7), and cervical or vaginal ulcers (OR, 2.7; 95% CI, 1.2-5.8) were significantly associated with infant infection, independent of plasma virus load. Breast-feeding (OR, 1.7; 95% CI, 1.0-2.9) and mastitis (relative risk [RR], 3.9; 95% CI, 1.2-12.7) were associated with increased transmission overall, and mastitis (RR, 21.8; 95% CI, 2.3-211.0) and breast abscess (RR, 51.6; 95% CI, 4.7-571.0) were associated with late transmission (occurring >2 months postpartum). Use of methods that decrease infant exposure to HIV-1 in maternal genital secretions or breast milk may enhance currently recommended perinatal HIV-1 interventions.
John
G C
GC
Department of Medicine, University of Washington, Seattle, WA, USA. gjohn@u.washington.edu
Nduati
R W
RW
Mbori-Ngacha
D A
DA
Richardson
B A
BA
Panteleeff
D
D
Mwatha
A
A
Overbaugh
J
J
Bwayo
J
J
Ndinya-Achola
J O
JO
Kreiss
J K
JK
D000293:Adolescent; D000328:Adult; D001903:Bottle Feeding; D001942:Breast Feeding; D016022:Case-Control Studies; D002584:Cervix Uteri / Q000821:virology; D002675:Child, Preschool; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D015658:HIV Infections / Q000635:transmission* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification* / Q000502:physiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D007630:Kenya; D008413:Mastitis / Q000821:virology; D008895:Milk, Human / Q000821:virology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology*; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D014621:Vagina / Q000821:virology; D019562:Viral Load; D017201:Virus Shedding
D004279:DNA, Viral; D012367:RNA, Viral