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Association of Maternal Viral Load and CD4 Count With Perinatal HIV-1 Transmission Risk During Breastfeeding in the PROMISE Postpartum Component. | LitMetric

AI Article Synopsis

  • - The study compared two groups of breastfeeding mothers with HIV: one receiving maternal antiretroviral therapy (mART) and the other receiving infant nevirapine prophylaxis (iNVP), both showing low rates of HIV transmission (<1%).
  • - Researchers monitored maternal viral load (MVL) and CD4 cell counts, assessing their impact on infant HIV transmission risk, finding that time-varying MVL and CD4 counts had significant associations with HIV infection risk in the mART group but not in the iNVP group.
  • - The results indicate that among mothers on mART, higher MVL and lower CD4 counts during breastfeeding corresponded to a greater risk of transmitting HIV to their infants.

Article Abstract

Background: Breastfeeding mothers with HIV infection not qualifying for antiretroviral therapy (ART) based on country-specific guidelines at the time of the Promoting Maternal-Infant Survival Everywhere trial and their uninfected neonates were randomized to maternal ART (mART) or infant nevirapine prophylaxis (iNVP) postpartum. HIV transmission proportions were similar (<1%) in the 2 arms. We assessed whether maternal viral load (MVL) and CD4 cell counts were associated with breastfeeding HIV transmission.

Methods: MVL was collected at entry (7-14 days postpartum) and at weeks 6, 14, 26, and 50 postpartum. CD4 cell counts were collected at entry and weeks 14, 26, 38, and 50 postpartum. Infant HIV-1 nucleic acid test was performed at weeks 1 and 6, every 4 weeks until week 26, and then every 12 weeks. The associations of baseline and time-varying MVL and CD4 cell counts with transmission risk were assessed using time-to-event analyses by randomized treatment arm.

Results: Two thousand four hundred thirty-one mother-infant pairs were enrolled in the study. Baseline MVL (P = 0.11) and CD4 cell counts (P = 0.51) were not significantly associated with infant HIV-1 infection. Time-varying MVL was significantly associated with infant HIV-1 infection {hazard ratio [95% confidence interval (CI)]: 13.96 (3.12 to 62.45)} in the mART arm but not in the iNVP arm [hazard ratio (95% CI): 1.04 (0.20 to 5.39)]. Time-varying CD4 cell counts were also significantly associated with infant HIV-1 infection [hazard ratio (95% CI): 0.18 (0.03 to 0.93)] in the mART arm but not in the iNVP arm [hazard ratio (95% CI): 0.38 (0.08 to 1.77)].

Conclusions: In women receiving mART, increased MVL and decreased CD4 cell counts during breastfeeding were associated with increased risk of infant HIV-1 infection.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8434954PMC
http://dx.doi.org/10.1097/QAI.0000000000002744DOI Listing

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