Evaluation of postpartum HIV superinfection and mother-to-child transmission
Published Date:Jul 31 2015
CD4 Lymphocyte Count
High-Throughput Nucleotide Sequencing
HIV Core Protein P24
HIV Envelope Protein Gp41
Infectious Disease Transmission, Vertical
Randomized Controlled Trials As Topic
Sequence Analysis, DNA
Pubmed Central ID:PMC4609898
Funding:1R01-AI087139/AI/NIAID NIH HHS/United States
5-U50-PS022061-05/PS/NCHHSTP CDC HHS/United States
R01 AI087139/AI/NIAID NIH HHS/United States
U50-CC0222061/CC/ODCDC CDC HHS/United States
UM1 AI068613/AI/NIAID NIH HHS/United States
UM1-AI068613/AI/NIAID NIH HHS/United States
Intramural NIH HHS/United States
This study examined HIV superinfection (HIV SI) in HIV-infected women postpartum, and its association with mother-to-child transmission (MTCT).
Plasma samples were obtained from HIV-infected women who transmitted HIV to their infants after 6 weeks of age (transmitters, n=91) and HIV-infected women who did not transmit HIV to their infants (non-transmitters, n=91). These women were originally enrolled in a randomized trial for prevention of MTCT of HIV in Malawi (PEPI-Malawi).
Two HIV genomic regions (p24 and gp41) were analyzed by next generation sequencing (NGS) for HIV SI. HIV SI was established if the follow-up sample contained a new, phylogenetically distinct viral population. HIV SI and transmission risk were examined by multiple logistic regression, adjusted for PEPI study arm, baseline viral load, baseline CD4 cell count, time to resumption of sex, and breastfeeding duration.
Transmitters had lower baseline CD4 cell counts (p=0.001) and higher viral loads (p<0.0001) compared to non-transmitters. There were five cases of SI among transmitters [rate of SI=4.7/100pys person year (pys)] compared to five cases among the non-transmitters (rate of SI=4.4/100pys; p=0.78). HIV SI was not associated with increased risk of post-natal MTCT of HIV after controlling for maternal age, baseline viral load and CD4 cell count (adjusted odds ratio=2.32, p=0.30). Longer breastfeeding duration was independently associated with a lower risk of HIV SI after controlling for study arm and baseline viral load (p=0.05).
There was a significant level of HIV SI in women postpartum, but this was not associated with an increased risk of MTCT via breastfeeding.
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