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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Predictors of early and late mother-to-child transmission of HIV in a breastfeeding population: HIV network for prevention trials 012 experience, Kampala, Uganda
Journal of Acquired Immune Deficiency Syndromes, Volume 52, No. 1, Year 2009
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Description
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 ≤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. © 2009 Lippincott Williams & Wilkins, Inc.
Authors & Co-Authors
Mmiro, Francis A.
Uganda, Kampala
Mu-ucsf Research Collaboration
Aizire, Jim
Uganda, Kampala
Mu-ucsf Research Collaboration
Mwatha, Anthony K.
United States, Seattle
Fred Hutchinson Cancer Research Center
Eshleman, Susan H.
United States, Baltimore
Johns Hopkins School of Medicine
Donnell, Deborah J.
United States, Seattle
Fred Hutchinson Cancer Research Center
Fowler, Mary Glenn
United States, Baltimore
Johns Hopkins School of Medicine
Nakabiito, Clemensia
Uganda, Kampala
Mu-ucsf Research Collaboration
Musoke, Philippa Martha
Uganda, Kampala
Mu-ucsf Research Collaboration
Jackson, J. Brooks
United States, Baltimore
Johns Hopkins School of Medicine
Guay, Laura A.
Uganda, Kampala
Mu-ucsf Research Collaboration
United States, Baltimore
Johns Hopkins School of Medicine
Statistics
Citations: 42
Authors: 10
Affiliations: 3
Identifiers
Doi:
10.1097/QAI.0b013e3181afd352
ISSN:
15254135
Research Areas
Cancer
Environmental
Infectious Diseases
Maternal And Child Health
Study Design
Randomised Control Trial
Cross Sectional Study
Cohort Study
Study Approach
Quantitative
Study Locations
Uganda