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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Predictors of intrauterine and intrapartum transmission of HIV-1 among Tanzanian women
AIDS, Volume 15, No. 9, Year 2001
Notification
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Description
Objective: To examine predictors of vertical transmission of HIV-1 in Dar-es-Salaam, Tanzania. Design: Observational design. Methods: Consenting HIV-1-infected pregnant women (n = 1078) were enrolled in a trial to examine the role of vitamin supplements. Intrauterine HIV-1 infection (HIV-positive at birth); intrapartum and early breastfeeding transmission (HIV-positive at 6 weeks among those uninfected at birth) were defined using the PCR. Results: Of 734 infants who had a specimen taken at birth, 62 were HIV positive [8.4%; 95% confidence interval (Cl),6.4-10.5%], whereas 59 infants were positive among 367 infants who were uninfected at birth and were retested at 6 weeks (16.1%; 95%Cl, 12.3-19.8%). In multivariate analyses, maternal CD4 cell count, viral load, and clinical stage were significant predictors of both definitions of transmission. Viral load of 50 000 copies/ml or more at delivery was associated with a 4.21-fold increase in risk of intrapartum and early breastfeeding transmission (95%Cl, 1.59-11.13; P = 0.004). Babies who were HIV negative at birth and born before 34 weeks of gestation were 2.19 times more likely to become infected during intrapartum and early breastfeeding periods compared with those born after 37 weeks (95%Cl, 1.19-4.04; P = 0.01). Gonorrhea at baseline was related to intrauterine transmission [multivariate risk ratio (RR), 5.50; 95%Cl, 2.04-14.81; P< 0.001] but not intrapartum and early breastfeeding transmission. Signs of lower genital infections at or after enrollment were also associated with transmission. Conclusions: Reducing prematurity, rate of HIV disease progression, and maternal viral load at or after delivery could help to reduce vertical transmission. Treatment of sexually transmitted infections at onset of prenatal care, about 20 weeks on average, was inadequate for prevention of transmission. Whether sustained clearance of lower genital tract infections result in reduced transmission remains to be determined. © 2001 Lippincott Williams & Wilkins.
Authors & Co-Authors
Fawzi, Wafaie W.
United States, Boston
Harvard T.h. Chan School of Public Health
United States, Boston
School of Public Health
Msamanga, Gernard I.
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Renjifo, Boris R.
United States, Boston
Harvard T.h. Chan School of Public Health
Spiegelman, Donna L.
United States, Boston
Harvard T.h. Chan School of Public Health
Urassa, Ernest J.N.
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Hashemi, Lobat
United States, Boston
Harvard T.h. Chan School of Public Health
Antelman, Gretchen
United States, Boston
Harvard T.h. Chan School of Public Health
Essex, Max E.
United States, Boston
Harvard T.h. Chan School of Public Health
Hunter, D. J.
United States, Boston
Harvard T.h. Chan School of Public Health
Statistics
Citations: 95
Authors: 9
Affiliations: 3
Identifiers
Doi:
10.1097/00002030-200106150-00011
Research Areas
Infectious Diseases
Maternal And Child Health
Sexual And Reproductive Health
Study Locations
Tanzania
Participants Gender
Female