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.
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.
Authors: Vanessa L Naidoo; Jaclyn K Mann; Christie Noble; Emily Adland; Jonathan M Carlson; Jake Thomas; Chanson J Brumme; Christina F Thobakgale-Tshabalala; Zabrina L Brumme; Mark A Brockman; Philip J R Goulder; Thumbi Ndung'u Journal: J Virol Date: 2017-08-10 Impact factor: 5.103
Authors: Christina F Thobakgale; Hendrik Streeck; Nompumelelo Mkhwanazi; Zenele Mncube; Lungile Maphumulo; Fundisiwe Chonco; Andrew Prendergast; Gareth Tudor-Williams; Bruce D Walker; Philip J R Goulder; Marcus Altfeld; Thumbi Ndung'u Journal: AIDS Res Hum Retroviruses Date: 2011-03-21 Impact factor: 2.205
Authors: Shabir A Madhi; Alane Izu; Avye Violari; Mark F Cotton; Ravindre Panchia; Els Dobbels; Poonam Sewraj; Nadia van Niekerk; Patrick Jean-Philippe; Peter V Adrian Journal: Vaccine Date: 2012-12-08 Impact factor: 3.641
Authors: Arne Schneidewind; Yanhua Tang; Mark A Brockman; Elizabeth G Ryland; Jacqueline Dunkley-Thompson; Julianne C Steel-Duncan; M Anne St John; Joseph A Conrad; Spyros A Kalams; Francine Noel; Todd M Allen; Celia D Christie; Margaret E Feeney Journal: J Virol Date: 2009-06-10 Impact factor: 5.103
Authors: Ellen Gould Chadwick; Jorge Pinto; Ram Yogev; Carmelita G Alvero; Michael D Hughes; Paul Palumbo; Brian Robbins; Rohan Hazra; Leslie Serchuck; Barbara E Heckman; Lynette Purdue; Renee Browning; Katherine Luzuriaga; John Rodman; Edmund Capparelli Journal: Pediatr Infect Dis J Date: 2009-03 Impact factor: 2.129
Authors: Sarah Finocchario-Kessler; Brad J Gautney; Samoel Khamadi; Vincent Okoth; Kathy Goggin; Jennifer K Spinler; Anne Mwangi; Davies Kimanga; Kristine F Clark; Helen D Olungae; Geoffrey A Preidis Journal: AIDS Date: 2014-07 Impact factor: 4.177