Correlates of mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission: association with maternal plasma HIV-1 RNA load, genital HIV-1 DNA shedding, and breast infections

J Infect Dis. 2001 Jan 15;183(2):206-212. doi: 10.1086/317918. Epub 2000 Dec 15.

Abstract

To determine the effects of plasma, genital, and breast milk human immunodeficiency virus type 1 (HIV-1) and breast infections on perinatal HIV-1 transmission, a nested case-control study was conducted within a randomized clinical trial of breast-feeding and formula feeding among HIV-1-seropositive mothers in Nairobi, Kenya. In analyses comparing 92 infected infants with 187 infants who were uninfected at 2 years, maternal viral RNA levels >43,000 copies/mL (cohort median) were associated with a 4-fold increase in risk of transmission (95% confidence interval [CI], 2.2-7.2). Maternal cervical HIV-1 DNA (odds ratio [OR], 2.4; 95% CI, 1.3-4.4), vaginal HIV-1 DNA (OR, 2.3; 95% CI, 1.1-4.7), and cervical or vaginal ulcers (OR, 2.7; 95% CI, 1.2-5.8) were significantly associated with infant infection, independent of plasma virus load. Breast-feeding (OR, 1.7; 95% CI, 1.0-2.9) and mastitis (relative risk [RR], 3.9; 95% CI, 1.2-12.7) were associated with increased transmission overall, and mastitis (RR, 21.8; 95% CI, 2.3-211.0) and breast abscess (RR, 51.6; 95% CI, 4.7-571.0) were associated with late transmission (occurring >2 months postpartum). Use of methods that decrease infant exposure to HIV-1 in maternal genital secretions or breast milk may enhance currently recommended perinatal HIV-1 interventions.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Bottle Feeding
  • Breast Feeding
  • Case-Control Studies
  • Cervix Uteri / virology
  • Child, Preschool
  • DNA, Viral / analysis
  • Female
  • HIV Infections / transmission*
  • HIV Infections / virology
  • HIV-1 / isolation & purification*
  • HIV-1 / physiology
  • Humans
  • Infant
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical*
  • Kenya
  • Mastitis / virology
  • Milk, Human / virology
  • Pregnancy
  • Pregnancy Complications, Infectious / virology*
  • RNA, Viral / blood
  • Risk Factors
  • Vagina / virology
  • Viral Load
  • Virus Shedding

Substances

  • DNA, Viral
  • RNA, Viral