Journal
JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
Volume 52, Issue 1, Pages 32-39Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAI.0b013e3181afd352
Keywords
early/late postnatal; MTCT; HIV-1
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Funding
- NIAID NIH HHS [U01-AI-48054, U01-AI-46745, U01-AI-069530, U01-AI-068613, U01 AI068613-04, U01 AI046702, U01 AI046745, N01 AI045200, N01 AI035173, U01 AI068632, U01-AI-068632, U01 AI068613, U01 AI048054, U01-AI-046702, U01 AI069530, U01 AI068632-03, N01-AI-35173-417] Funding Source: Medline
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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 :556 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.
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