Maternal viral load and rate of disease progression among vertically HIV-1-infected children: an international meta-analysis.
OBJECTIVE
To evaluate whether maternal human immunodeficiency virus type 1 (HIV-1) RNA levels in the serum/plasma of mothers at or close to the time of delivery affects the rate of disease progression among vertically HIV-1-infected children and whether it correlates with other parameters affecting infant disease progression.


METHODS
International meta-analysis of eight studies with 574 HIV-1 infected infants with available maternal HIV-1 RNA measurements at or close to delivery and clinical follow-up. The primary outcome was disease progression (stage C disease or death, n = 178). Cohort-stratified Cox models were used.


RESULTS
Higher maternal HIV-1 RNA level at or close to delivery significantly increased disease progression risk [hazard ratio (HR), 1.25; 95% confidence interval (CI), 1.04-1.52 per 1 log10 increase; P = 0.02) with a borderline effect on mortality (HR, 1.26; 95% CI, 0.96-1.65; P = 0.10]. The association with disease progression risk was strong in the first 6 months of life (HR, 1.77; 95% CI, 1.28-2.45; P = 0.001), but not subsequently (HR, 1.03; 95% CI, 0.81-1.30). Maternal HIV-1 RNA, early infant HIV-1 RNA (at 30-200 days after birth) and infant CD4 were independent predictors of disease progression in the first 6 months. Maternal HIV-1 RNA at or close to delivery correlated with early infant HIV-1 RNA (r = 0.26, P < 0.001). Effects were independent of maternal and infant treatment.


CONCLUSIONS
Higher maternal HIV-1 RNA at or close to delivery strongly predicts disease progression for HIV-1-infected infants, especially in their first 6 months of life and correlates with the early peak of viremia in the infected child.
Ioannidis
John P A
JP
Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece. jioannid@cc.uoi.gr
Tatsioni
Athina
A
Abrams
Elaine J
EJ
Bulterys
Marc
M
Coombs
Robert W
RW
Goedert
James J
JJ
Korber
Bette T
BT
Mayaux
Marie Jeanne
MJ
Mofenson
Lynne M
LM
Moye
Jack
J
Newell
Marie-Louise
ML
Shapiro
David E
DE
Teglas
Jean Paul
JP
Thompson
Bruce
B
Wiener
Jeffrey
J
D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000635:transmission / Q000821:virology*; D015497:HIV-1; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D009035:Mothers; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D019562:Viral Load / Q000379:methods*
D044966:Anti-Retroviral Agents; D012367:RNA, Viral