Correlates of Mother‐to‐Child Human Immunodeficiency Virus Type 1 (HIV‐1) Transmission: Association with Maternal Plasma HIV‐1 RNA Load, Genital HIV‐1 DNA Shedding, and Breast Infections

Grace C. John, Ruth W. Nduati, Dorothy A. Mbori‐Ngacha, Barbra A. Richardson, Dana Panteleeff, Anthony Mwatha, Julie Overbaugh, Job Bwayo, Jeckoniah O. Ndinya‐Achola, Joan K. Kreiss
2001 Journal of Infectious Diseases  
To determine the effects of plasma, genital, and breast milk human immunodeficiency virus type 1 (HIV-1) and breast infections on perinatal HIV-1 transmission, a nested case-control study was conducted within a randomized clinical trial of breast-feeding and formula feeding among HIV-1-seropositive mothers in Nairobi, Kenya. In analyses comparing 92 infected infants with 187 infants who were uninfected at 2 years, maternal viral RNA levels 143,000 copies/mL (cohort median) were associated with
more » ... 4-fold increase in risk of transmission (95% confidence interval [CI], 2.2-7.2). Maternal cervical HIV-1 DNA (odds ratio [OR], 2.4; 95% CI, 1.3-4.4), vaginal HIV-1 DNA (OR, 2.3; 95% CI, 1.1-4.7), and cervical or vaginal ulcers (OR, 2.7; 95% CI, 1.2-5.8) were significantly associated with infant infection, independent of plasma virus load. Breast-feeding (OR, 1.7; 95% CI, 1.0-2.9) and mastitis (relative risk [RR], 3.9; 95% CI, 1.2-12.7) were associated with increased transmission overall, and mastitis (RR, 21.8; 95% CI, 2.3-211.0) and breast abscess (RR, 51.6; 95% CI, 4.7-571.0) were associated with late transmission (occurring 12 months postpartum). Use of methods that decrease infant exposure to HIV-1 in maternal genital secretions or breast milk may enhance currently recommended perinatal HIV-1 interventions.
doi:10.1086/317918 pmid:11120927 fatcat:hbuulqrf7bgi7jglhjauqf3u6u