期刊
AIDS
卷 25, 期 11, 页码 1357-1364出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAD.0b013e3283489d45
关键词
HIV; incidence; Malawi; mother-to-child transmission; multiassay algorithm
资金
- International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) Group [U01-AI068633]
- American Recovery and Reinvestment Act award [3U01AI068632-05S3]
- National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH)
- National Institute on Drug Abuse, National Institutes of Health (NIH)
- National Institute of Mental Health, National Institutes of Health (NIH)
- Office of AIDS Research, National Institutes of Health (NIH)
- Department of Health and Human Services (DHHS) [U01AI068613]
- Centers for Disease Control and Prevention [U50/CCU022061]
- Partners in Prevention HSV/HIV Transmission Study [26469]
- Hormonal Contraception and HIV Acquisition (HC-HIV) Study [N01-HD-0-3310]
- Division of Intramural Research, NIAID, NIH
Objective: We previously developed a multiassay algorithm (MAA) to identify recent HIV infection that includes the BED-capture enzyme immunoassay, an avidity assay based on the Genetic Systems HIV-1/HIV-2+O enzyme immunoassay, CD4 cell count, and HIV viral load. We used this MAA to evaluate the association between recent maternal HIV infection and in-utero transmission of HIV. Methods: Plasma samples were collected at delivery from 2561 HIV-infected women in the postexposure prophylaxis of infants-Malawi trial. The MAA described above was used to identify women with recent HIV infection. Logistic regression models assessed association between recent HIV infection and in-utero HIV transmission (defined as a positive infant HIV DNA test at birth). Results: Seventy-three women were identified as recently infected using the MAA. Those women were younger and had lower parity than women who were identified as not recently infected using the MAA (P<0.0001 for age and parity). The frequency of in-utero HIV transmission was 17.8% among women identified as recently infected, compared with 6.7% among women identified as not recently infected (13/73 vs. 166/2488, P = 0.001). In a multivariate model, three factors were independently associated with in-utero HIV transmission: recent infection [adjusted odds ratio (AOR): 2.49, 95% confidence interval (CI): 1.30-4.78, P = 0.006], log(10) HIV viral load at delivery (AOR: 2.01, 95% CI: 1.60-2.51, P<0.0001), and younger age (per 10 year increase, AOR: 0.66, 95% CI: 0.43-0.93, P = 0.02). Conclusion: Results obtained using a MAA suggest that recent maternal HIV acquisition is strongly associated with in-utero HIV transmission, independent of HIV viral load at delivery. (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins
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