Gender differences in perinatal HIV acquisition among African infants.
OBJECTIVE
We investigated gender-specific risks of mother-to-child transmission (MTCT) at birth and at 6 to 8 weeks among infants born to HIV-infected African women.


METHODS
Follow-up study of infants enrolled in 2 randomized, phase III, clinical trials to prevent MTCT, conducted in Blantyre, Malawi, in southeast Africa.


METHODS
Infants were enrolled at birth and monitored postnatally, and their HIV status was assessed at birth and at 6 to 8 weeks (assessment beyond 6-8 weeks is ongoing). Statistical analyses were stratified according to gender, and comparisons were made with descriptive, univariate, and multivariate statistical tests. MTCT was estimated at birth and at 6 to 8 weeks among infants who were not infected at birth.


RESULTS
Overall, 966 boys and 998 girls were enrolled. The rate of HIV transmission at birth was 9.5% (187 of 1964 infants). However, at birth significantly more girls (12.6%) than boys (6.3%) were infected with HIV. This association remained significant after controlling for maternal viral load and other factors. Among infants who were uninfected at birth, 8.7% (135 of 1554 infants) acquired HIV by 6 to 8 weeks; of these infants, more girls acquired HIV (10.0%), compared with boys (7.4%).


CONCLUSIONS
Female infants may be more susceptible to HIV infection before birth and continuing after birth. Alternatively, in utero mortality rates of HIV-infected male infants may be disproportionately higher and thus more HIV-infected female infants are born. In areas of sub-Saharan Africa, where HIV infection rates are high among women of reproductive age, the magnitude of the gender transmission differences observed in this study could have clinical, preventive, and demographic implications.
Taha
Taha E
TE
Infectious Diseases Program, Department of Epidemiology, Bloomberg School of Public Health, MBBS, Room E7138, 615 N Wolfe St, Baltimore, MD 21205, USA. ttaha@jhsph.edu
Nour
Samah
S
Kumwenda
Newton I
NI
Broadhead
Robin L
RL
Fiscus
Susan A
SA
Kafulafula
George
G
Nkhoma
Chiwawa
C
Chen
Shu
S
Hoover
Donald R
DR
D001724:Birth Weight; D005260:Female; D005313:Fetal Death / Q000821:virology; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission*; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008295:Malawi; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011336:Probability; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012737:Sex Factors