Predictors of Early and Late Mother-to-Child Transmission of HIV in a Breastfeeding Population: HIV Network for Prevention Trials 012 Experience, Kampala, Uganda

Francis A MMIRO; Jim AIZIRE; Anthony K MWATHA; Susan H ESHLEMAN; Deborah DONNELL; Mary Glenn FOWLER; Clemensia NAKABIITO; Philippa M MUSOKE; J. Brooks JACKSON; Laura A GUAY

doi:10.1097/QAI.0b013e3181afd352

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Predictors of Early and Late Mother-to-Child Transmission of HIV in a Breastfeeding Population: HIV Network for Prevention Trials 012 Experience, Kampala, Uganda

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Predictors of Early and Late Mother-to-Child Transmission of HIV in a Breastfeeding Population: HIV Network for Prevention Trials 012 Experience, Kampala, Uganda

Francis A MMIRO, Jim AIZIRE, Anthony K MWATHA, Susan H ESHLEMAN, Deborah DONNELL, Mary Glenn FOWLER, Clemensia NAKABIITO, Philippa M MUSOKE, J. Brooks JACKSON and Laura A GUAY

Journal of acquired immune deficiency syndromes (1999), Vol.52(1), pp.32-39

2009

DOI: 10.1097/QAI.0b013e3181afd352

PMCID: PMC2767188

PMID: 19617849

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Abstract

Objective: To determine the predictors for early versus later (breastfeeding) transmission of HIV-1. Methods: Secondary data analysis was performed on HIV Network for Prevention Trials 012, a completed randomized clinical trial assessing the relative efficacy of nevirapine (NVP) versus zidovudine in reducing mother-to-child transmission (MTCT) of HIV-1. We used Cox regression analysis to assess risk factors for MTCT. The ViroSeq HIV genotyping and a sensitive point mutation assay were used to detect NVP resistance mutations. Results: In this subset analyses, 122 of 610 infants were HIV infected, of whom 99 (81.1%) were infected early (first positive polymerase chain reaction < or =56 days). Incidence of MTCT after 56 days was low [0.7% per month (95% confidence interval, CI: 0.4 to 1.0)], but continued through 18 months. In multivariate analyses, early MTCT "factors" included NVP versus zidovudine (hazard ratio (HR) = 0.57, 95% CI: 0.38 to 0.86), pre-entry maternal viral load (VL, HR = 1.76, 95% CI: 1.28 to 2.41), and CD4 cell count (HR = 1.16, 95% CI: 1.05 to 1.28). Maternal VL (6-8 weeks) was associated with late MTCT (HR = 3.66, 95% CI: 1.78 to 7.50), whereas maternal NVP resistance (6-8 weeks) was not. Conclusions: Maternal VL was the best predictor of both early and late transmission. Maternal NVP resistance at 6-8 weeks did not predict late transmission.

Infectious Diseases

Microbiology

Virology

Fundamental and applied biological sciences. Psychology

Miscellaneous

Viral diseases

Biological and medical sciences

Medical sciences

Human viral diseases

Details

Title: Subtitle: Predictors of Early and Late Mother-to-Child Transmission of HIV in a Breastfeeding Population: HIV Network for Prevention Trials 012 Experience, Kampala, Uganda
Creators: Francis A MMIRO - Makerere University―Johns Hopkins University Research Collaboration, Kampala, Uganda
Jim AIZIRE - Makerere University―Johns Hopkins University Research Collaboration, Kampala, Uganda
Anthony K MWATHA - Statistical Center for HIV/AIDS Research & Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
Susan H ESHLEMAN - Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
Deborah DONNELL - Statistical Center for HIV/AIDS Research & Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
Mary Glenn FOWLER - Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
Clemensia NAKABIITO - Makerere University―Johns Hopkins University Research Collaboration, Kampala, Uganda
Philippa M MUSOKE - Makerere University―Johns Hopkins University Research Collaboration, Kampala, Uganda
J. Brooks JACKSON - Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
Laura A GUAY - Makerere University―Johns Hopkins University Research Collaboration, Kampala, Uganda
Resource Type: Journal article
Publication Details: Journal of acquired immune deficiency syndromes (1999), Vol.52(1), pp.32-39
DOI: 10.1097/QAI.0b013e3181afd352
PMID: 19617849
PMCID: PMC2767188
NLM abbreviation: J Acquir Immune Defic Syndr
ISSN: 1525-4135
eISSN: 1944-7884
Publisher: Lippincott Williams & Wilkins; Hagerstown, MD
Language: English
Date published: 2009
Academic Unit: Pathology; VPMA - Administration
Record Identifier: 9984047691202771

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