Journal article
Predictors of Perinatal HIV Transmission Among Women Without Prior Antiretroviral Therapy in a Resource-Limited Setting The Breastfeeding, Antiretrovirals and Nutrition Study
The Pediatric infectious disease journal, Vol.38(5), pp.508-512
05/01/2019
DOI: 10.1097/INF.0000000000002220
PMCID: PMC6481191
PMID: 30985546
Abstract
Background: To investigate potential risk factors for perinatal (intrauterine and intrapartum) mother-to-child transmission (MTCT) of HIV in women unexposed to antiretroviral therapy (ART) during pregnancy. Methods: We compared factors according to perinatal MTCT outcome among 2275 ART-naive (until the onset of labor) HIV-infected women in the Breastfeeding, Antiretrovirals and Nutrition study (2004-2010) in Lilongwe, Malawi. Factors included HIV viral load during pregnancy, food security, demographic characteristics, hematologic and blood chemistry measures, medical history and physical factors. Associations with perinatal MTCT and interactions with maternal viral load were assessed using simple and multivariable logistic regression. Results: There were 119 (115 intrauterine and 4 intrapartum) cases of perinatal MTCT, only one to a mother with 10,000 copies/mL were common (63.1%). Lower maternal viral load (<1000 copies/mL and 1000.1-10,000 copies/mL) was associated with reduced odds of perinatal MTCT [adjusted odds ratio (aOR), 0.1; 95% confidence interval (CI): 0.01-0.4 and aOR, 0.2; 95% CI: 0.1-0.4, respectively), compared with maternal viral load >10,000 copies/mL. Low CD4+ T cell count (<= 350 cells/mu L) was only associated with perinatal MTCT in unadjusted models. Food shortage (aOR, 1.8; 95% CI: 1.2-2.6), sexually transmitted infection (STI) (past year; aOR, 1.9; 95% CI: 1.0-3.7), histories of herpes zoster (aOR, 3.0; 95% CI: 1.6-5.6) and tuberculosis (aOR, 2.5; 95% CI: 1.1-5.7) were associated with increased odds of perinatal MTCT. Conclusions: These findings confirm that lowering maternal HIV viral load is most important in preventing perinatal MTCT and support efforts to address food shortage, STI and tuberculosis prevention, while informing programs to improve ART coverage in pregnancy.
Details
- Title: Subtitle
- Predictors of Perinatal HIV Transmission Among Women Without Prior Antiretroviral Therapy in a Resource-Limited Setting The Breastfeeding, Antiretrovirals and Nutrition Study
- Creators
- Alexander C. Ewing - Centers for Disease Control and PreventionSascha R. Ellington - Centers for Disease Control and PreventionJeffrey B. Wiener - Centers for Disease Control and PreventionCharles S. Chasela - University of the WitwatersrandGerald Tegha - UNC Project, Lilongwe, MalawiJulie A. E. Nelson - University of North Carolina at Chapel HillDenise J. Jamieson - Centers for Disease Control and PreventionCharles van der Horst - University of North Carolina at Chapel HillAthena P. Kourtis - Centers for Disease Control and PreventionBreastfeeding, Antiretrovirals and Nutrition (BAN) Study Team
- Resource Type
- Journal article
- Publication Details
- The Pediatric infectious disease journal, Vol.38(5), pp.508-512
- DOI
- 10.1097/INF.0000000000002220
- PMID
- 30985546
- PMCID
- PMC6481191
- NLM abbreviation
- Pediatr Infect Dis J
- ISSN
- 0891-3668
- eISSN
- 1532-0987
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 5
- Grant note
- D43 TW001039; R24 TW007988 / FIC NIH HHS; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH Fogarty International Center (FIC) P30AI050410 / NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Allergy & Infectious Diseases (NIAID) P30 AI050410 / NIAID NIH HHS; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Allergy & Infectious Diseases (NIAID) R24 HD050924 / NICHD NIH HHS; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) U48 DP001944; U48 DP000059 / NCCDPHP CDC HHS
- Language
- English
- Date published
- 05/01/2019
- Academic Unit
- Obstetrics and Gynecology; VPMA - Administration
- Record Identifier
- 9984446399902771
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