Evaluation of postpartum HIV superinfection and mother-to-child transmission. (31st July 2015)

• Record Type: Journal Article
• Authors: Redd, Andrew D.; Wendel, Sarah K.J.; Longosz, Andrew F.; Fogel, Jessica M.; Dadabhai, Sufia; Kumwenda, Newton; Sun, Jin; Walker, Michael P.; Bruno, Daniel; Martens, Craig; Eshleman, Susan H.; Porcella, Stephen F.; Quinn, Thomas C.; Taha, Taha E.
• Is Part Of: AIDS. Volume 29:Number 12(2015)
• Publication Date: 2015-07-31
• Subjects: AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome; AIDS (Disease); Periodicals; Periodicals; 616.9792005
• DOI: 10.1097/QAD.0000000000000740
• Languages: English
• ISSNs: 0269-9370

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Objective:</title> <p>This study examined HIV superinfection in HIV-infected women postpartum, and its association with mother-to-child transmission (MTCT).</p> </sec> <sec> <title>Design:</title> <p>Plasma samples were obtained from HIV-infected women who transmitted HIV to their infants after 6 weeks of age (transmitters, <italic>n</italic> = 91) and HIV-infected women who did not transmit HIV to their infants (nontransmitters, <italic>n</italic> = 91). These women were originally enrolled in a randomized trial for prevention of MTCT of HIV in Malawi (Post-Exposure Prophylaxis of Infants trial in Malawi).</p> </sec> <sec> <title>Methods:</title> <p>Two HIV genomic regions (p24 and gp41) were analyzed by next-generation sequencing for HIV superinfection. HIV superinfection was established if the follow-up sample contained a new, phylogenetically distinct viral population. HIV superinfection and transmission risk were examined by multiple logistic regression, adjusted for Post-Exposure Prophylaxis of Infants study arm, baseline viral load, baseline CD4<sup>+</sup> cell count, time to resumption of sex, and breastfeeding duration.</p> </sec> <sec> <title>Results:</title> <p>Transmitters had lower baseline CD4<sup>+</sup> cell counts (<italic>P</italic> = 0.001) and higher viral loads (<italic>P</italic> < 0.0001) compared with nontransmitters. There were five cases of superinfection among transmitters (rate of superinfection = 4.7/100 person-years) compared with five cases among the nontransmitters (rate of superinfection = 4.4/100 person-years; <italic>P</italic> = 0.78). HIV superinfection was not associated with increased risk of postnatal MTCT of HIV after controlling for maternal age, baseline viral load, and CD4<sup>+</sup> cell count (adjusted odds ratio = 2.32, <italic>P</italic> = 0.30). Longer breastfeeding duration was independently associated with a lower risk of HIV superinfection after controlling for study arm and baseline viral load (<italic>P</italic> = 0.05).</p> </sec> <sec> <title>Conclusion:</title> <p>There was a significant level of HIV superinfection in women postpartum, but this was not associated with an increased risk of MTCT via breastfeeding.</p> </sec> </abstract>