Pediatric HIV-1 in Kenya: pattern and correlates of viral load and association with mortality.
BACKGROUND
There is limited information regarding the pattern and correlates of viral replication in vertically HIV-1-infected children and its role on their outcomes in resource-limited settings.


METHODS
HIV-1-infected infants were followed from birth to 24 months. Serial HIV-1 RNA levels were compared in infants infected in utero (<48 hours), peripartum (48 hours-1 month), and late postnatal (after 1 month). Cofactors for viral peak [highest viral load (VL) within 6 months of infection] and set point and mortality were determined.


RESULTS
Among 85 HIV-1-infected infants, 24 were infected in utero, 41 peripartum, 13 late postnatal; 7 had no 48-hour assay. HIV-1 VL set point was significantly lower in infants infected >1 month vs. < or = 1 month (5.59 vs. 6.24 log10 copies per milliliter, P = 0.01). Maternal VL correlated with peak infant VL (P < 0.001). Univariately, infant peak and set point VL and 6-month CD4% <15% predicted mortality; and 6-month CD4% <15% remained independently predictive in multivariate analyses (hazard ratio = 4.85, 95% confidence interval: 1.90 to 12.36).


CONCLUSIONS
Infants infected after the age of 1 month contained virus better than infants infected before 1 month of age. Maternal VL predicted infant VL, which, in turn was associated with early mortality.
Obimbo
Elizabeth Maleche
EM
Department of Pediatrics, University of Nairobi, Nairobi, Kenya.
Wamalwa
Dalton
D
Richardson
Barbara
B
Mbori-Ngacha
Dorothy
D
Overbaugh
Julie
J
Emery
Sandra
S
Otieno
Phelgona
P
Farquhar
Carey
C
Bosire
Rose
R
Payne
Barbara Lohman
BL
John-Stewart
Grace
G
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000401:mortality / Q000821:virology*; D015497:HIV-1; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D007630:Kenya / Q000453:epidemiology; D008297:Male; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D019562:Viral Load; D055815:Young Adult