Primary HIV-1 infection in African children infected through breastfeeding.
OBJECTIVE
To describe acute retroviral syndrome and associated primary viraemia in African children infected with HIV-1 through breastfeeding.


METHODS
Matched case-control study performed retrospectively within the ANRS 049 DITRAME project conducted in 1995-1998 in Abidjan, Côte d'Ivoire.


METHODS
Cases were children infected by HIV-1 postnatally through breastfeeding. All were HIV-1 negative by DNA PCR at least 45 days of age, but positive on a subsequent sample. This period was considered as surrounding the estimated date of postnatal contamination. Signs/symptoms occurring within this period were recorded in cases and compared with those occurring during the same time period in uninfected breastfed children (controls). For cases, plasma specimens were tested for HIV-1 plasma RNA using the branched DNA assay.


RESULTS
Of 22 infants infected postnatally (median age at first positive sample, 185 days; range, 87-373 days), 21 (95.5%) exhibited at least one clinical sign, compared with only 27 of the 44 (61.4%) uninfected children (P = 0.003). Three independent factors were associated with primary HIV-1 infection: mononucleosis-like syndrome [odds ratio (OR), 8.3; 95% confidence interval (CI), 1.4-47.8], dermatitis (OR, 6.0; CI, 1.1-31.9), and generalized lymphadenopathy (OR, 26.5; CI, 2.0-348.4). Among cases, initial median plasma HIV-1 RNA viral load was 5.92 log10 copies/ml; this declined to 4.96 log10 12 months after the first positive viral load.


CONCLUSIONS
These results may be useful for the recognition of early paediatric cases of postnatal transmission in Africa and could enable targeting of those who should benefit from HIV RNA or DNA testing for primary HIV-1 infection and their subsequent care.
Rouet
François
F
CeDReS, CHU de Treichville, Abidjan, Côte d'Ivoire.
Elenga
Narcisse
N
Msellati
Philippe
P
Montcho
Crépin
C
Viho
Ida
I
Sakarovitch
Charlotte
C
Danel
Christine
C
Rouzioux
Christine
C
Leroy
Valériane
V
Dabis
François
F
D000208:Acute Disease; D001942:Breast Feeding / Q000009:adverse effects*; D016022:Case-Control Studies; D007560:Cote d'Ivoire; D004279:DNA, Viral / Q000097:blood; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000635:transmission* / Q000821:virology; D015497:HIV-1; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical; D016015:Logistic Models; D008297:Male; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D019562:Viral Load
D004279:DNA, Viral; D012367:RNA, Viral