HIV-1 viral load and other risk factors for mother-to-child transmission of HIV-1 in a breast-feeding population in Cote d'Ivoire.
Short-course antiretroviral regimens have been evaluated to reduce mother-to-child transmission of HIV in resource-limited settings. This report from Abidjan, Cote d'Ivoire, examines the risk factors for HIV transmission by 1 and 24 months among breast-feeding women. Eligible HIV-1-seropositive pregnant women enrolled in this randomized double-blind clinical trial were randomly assigned to receive either oral zidovudine (ZDV) (n = 126) prophylaxis or placebo (n = 124). Maternal prophylaxis began at 36 weeks of gestation (300 mg ZDV twice daily antepartum and 300 mg every 3 hours intrapartum); there was no neonatal prophylaxis component. The cumulative risk of transmission in the treatment group was 11.9% and 22.1% by 1 and 24 months, respectively. In adjusted analyses, viral load at enrollment was the strongest predictor of transmission (per log increment: odds ratio [OR] = 4.8, 95% confidence interval [CI]: 2.5-9.5 at 1 month; OR = 5.7; 95% CI: 3.1-10.8 at 24 months). Overall, ZDV prophylaxis was not significantly protective for infection at 1 or 24 months. Comparing ZDV with placebo following dichotomization of viral load (<50,000 vs. > or =50,000 copies/mL) at enrollment, however, there was a significant effect of ZDV seen only among those women with a low viral load at enrollment. The substantial risk of transmission despite ZDV prophylaxis, particularly among those with higher viral loads, underscores the need to find more effective regimens appropriate for use in resource-limited settings.
Jamieson
Denise J
DJ
Division of HIV/AIDS Prevention-Surveillance and Epidemiology, National Center fir HIV, STD, and TB prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. djamieson@cdc.gov
Sibailly
Toussaint S
TS
Sadek
Ramses
R
Roels
Thierry H
TH
Ekpini
Ehounou R
ER
Boni-Ouattara
Edith
E
Karon
John M
JM
Nkengasong
John
J
Greenberg
Alan E
AE
Wiktor
Stefan Z
SZ
D001942:Breast Feeding / Q000009:adverse effects*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D007560:Cote d'Ivoire; D004279:DNA, Viral / Q000737:chemistry / Q000235:genetics; D004311:Double-Blind Method; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control / Q000635:transmission / Q000821:virology; D015497:HIV-1; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000821:virology; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage*; D019562:Viral Load; D015215:Zidovudine / Q000008:administration & dosage*
D004279:DNA, Viral; D018894:Reverse Transcriptase Inhibitors; D015215:Zidovudine