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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Maternal-fetal microtransfusions and HIV-1 mother-to-child transmission in Malawi
PLoS Medicine, Volume 3, No. 1, Year 2006
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Description
Background: Between 25% and 35% of infants born to HIV-infected mothers become HIV-1 infected. One potential route of mother-to-child transmission (MTCT) could be through a breakdown in the placental barrier (i.e., maternal-fetal microtransfusions). Methods and Findings: Placental alkaline phosphatase (PLAP) is a 130-kD maternal enzyme that cannot cross the intact placental barrier. We measured PLAP activity in umbilical vein serum as an indicator of maternal-fetal microtransfusion, and related this to the risk of HIV-1 MTCT. A case-cohort study was conducted of 149 women randomly selected from a cohort of HIV-1-infected pregnant Malawians; these women served as a reference group for 36 cases of in utero MTCT and 43 cases of intrapartum (IP) MTCT. Cord PLAP activity was measured with an immunocatalytic assay. Infant HIV status was determined by real-time PCR. The association between cord PLAP activity and HIV-1 MTCT was measured with logistic regression using generalized estimating equations. Among vaginal deliveries, PLAP was associated with IP MTCT (risk ratio, 2.25 per log10 ng/ml PLAP; 95% confidence interval, 0.95-5.32) but not in utero MTCT. In a multivariable model adjusted for HIV-1 RNA load, chorioamnionitis, and self-reported fever, the risk of IP MTCT almost tripled for every log10 increase in cord PLAP activity (risk ratio, 2.87; 95% confidence interval, 1.05-7.83). Conclusion: These results suggest that during vaginal deliveries, placental microtransfusions are a risk factor for IP HIV-1 MTCT. Future studies are needed to identify factors that increase the risk for microtransfusions in order to prevent IP HIV-1 MTCT. © 2006 Kwiek et al.
Authors & Co-Authors
Kwiek, Jesse J.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Mwapasa, Victor
Malawi, Zomba
University of Malawi
Milner, Danny Arnold
United States, Boston
Brigham and Women's Hospital
Alker, Alisa P.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Miller, William C.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Tadesse, Eyob
Malawi, Zomba
University of Malawi
Molyneux, Malcolm Edward
Malawi, Zomba
University of Malawi
Rogerson, Stephen J.
Australia, Melbourne
University of Melbourne
Meshnick, Steven Richard
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Statistics
Citations: 55
Authors: 9
Affiliations: 4
Identifiers
Doi:
10.1371/journal.pmed.0030010
ISSN:
15491277
Research Areas
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
Malawi
Participants Gender
Female