High frequency of rapid immunological progression in African infants infected in the era of perinatal HIV prophylaxis.

Mphatswe, W; Blanckenberg, N; Tudor-Williams, G; Prendergast, A; Thobakgale, C; Mkhwanazi, N; McCarthy, N; Walker, B; Kiepiela, P; Goulder, P

Journal article

High frequency of rapid immunological progression in African infants infected in the era of perinatal HIV prophylaxis.

Abstract:: OBJECTIVES: To determine the natural history of HIV infection following peripartum single-dose nevirapine (sd-NVP) prophylaxis in a resource-limited country, and to assess implications for antiretroviral therapy (ART) roll-out programmes. METHODS: Infants of HIV-infected mothers in KwaZulu-Natal, South Africa, were tested on days 1 and 28 to detect intrauterine (IU) and intrapartum (IP) infection. Infant follow-up included monthly viral load and CD4 cell measurement. ART was initiated at infant CD4 cell% < or = 20%. RESULTS: In 740 infants born to 719 HIV-infected women, mother-to-child transmission (MTCT) was 10.3% (69% IU, 31% IP). Median viral load was higher in mothers of infants infected IP than IU (279 000 versus 86 600 copies/ml; P = 0.039) and lower in mothers of uninfected infants (median 26 750 copies/ml; P < 0.001). Peak viraemia was higher in infants infected IP than IU (5 160 000 versus 984 000 copies/ml; P < 0.001). Median viral load at birth in IU-infected infants (155 000 copies/ml) fell 1.4 log to 6510 copies/ml by day 5 and was beneath the detection limit using dried blood spot analysis in 38% of infants. CD4 cell% declined rapidly, to < or = 20% in 70% and < or = 25% in 85% [current World Health Organization (WHO) criteria for initiating ART] of infants by 6 months. CONCLUSIONS: MTCT was reduced by sd-NVP through an effect on IP transmission. Where MTCT occurred despite NVP, two-thirds of transmissions arose IU; IP-infected babies were born to mothers with very high viral load. Disease progression was particularly rapid, 85% infants meeting WHO criteria for ART within 6 months. These findings argue for more effective MTCT-prevention programmes in resource-limited countries.

Publication status:: Published

Actions

Email

Email this record

Send the bibliographic details of this record to your email address.

Your Email
Please enter the email address that the record information will be sent to.

-
Your message (optional)
Please add any additional information to be included within the email.
Cite

Cite this record

APA Style

Mphatswe, W., Blanckenberg, N., Tudor-Williams, G., Prendergast, A., Thobakgale, C., Mkhwanazi, N., McCarthy, N., Walker, B., Kiepiela, P., & Goulder, P. (2007). High frequency of rapid immunological progression in African infants infected in the era of perinatal HIV prophylaxis. AIDS (London, England), 21(10), 1253–1261.

MLA Style

Mphatswe, W., et al. “High Frequency of Rapid Immunological Progression in African Infants Infected in the Era of Perinatal HIV Prophylaxis.” AIDS (London, England), vol. 21, no. 10, 2007, pp. 1253–61.

Chicago Style

Mphatswe, W, N Blanckenberg, G Tudor-Williams, A Prendergast, C Thobakgale, N Mkhwanazi, N McCarthy, B Walker, P Kiepiela, and P Goulder. 2007. “High Frequency of Rapid Immunological Progression in African Infants Infected in the Era of Perinatal HIV Prophylaxis.” AIDS (London, England) 21 (10): 1253–61.
Share
Print