Jane R Millar1,2, Isabella Fatti3, Noxolo Mchunu3, Nomonde Bengu3, Nicholas E Grayson2,4, Emily Adland2, David Bonsall5, Moherndran Archary6, Philippa C Matthews4,7,8, Thumbi Ndung'u1,9,10,11,12, Philip Goulder1,2,9,10. 1. HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa. 2. Department of Paediatrics, University of Oxford, Oxford, UK. 3. Umkhuseli Innovation and Research Management, Pietermaritzburg, South Africa. 4. Nuffield Department of Medicine. 5. Nuffield Department of Medicine, Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK. 6. Department of Paediatrics, King Edward VIII Hospital/University of KwaZulu-Natal, Durban, South Africa. 7. Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust. 8. Oxford BRC, John Radcliffe Hospital, Oxford, UK. 9. Africa Health Research Institute (AHRI), Durban, South Africa. 10. Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA. 11. Max Planck Institute for Infection Biology, Berlin, Germany. 12. Division of Infection and Immunity, University College London, London, UK.
Abstract
OBJECTIVE: The worldwide incidence of pregnancy for women living with perinatal HIV infection is increasing. Subsequently, there is growing risk of second-generation mother-to-child HIV transmission. The infant clinical outcomes for such a phenomenon have yet to be described. DESIGN: As part of a wider observational study in KwaZulu-Natal, South Africa, six infants with in-utero HIV infection were identified as being born to mothers with perinatal HIV infection. METHODS: Blood results and clinical data were collected in the first 3 years of life. In two cases, sample availability allowed confirmation by phylogenetic analysis of grandmother-to-mother-to-child HIV transmission. RESULTS: Outcomes were poor in all six cases. All six mothers had difficulty administering twice daily combination antiretroviral therapy to their infants due to difficulties with acceptance, disclosure, poor health and being themselves long-term nonprogressors. Nonnucleoside reverse transcriptase inhibitor-resistant virus was detected in all mothers tested. None of the infants maintained suppression of viraemia on combination antiretroviral therapy. One infant died, and another was lost to follow-up. CONCLUSION: As the numbers of second-generation mother-to-child transmissions increase, it is important to highlight that this mother-infant dyad represents an extremely vulnerable group. In order for them to survive and thrive, these infants' mothers require their specific needs to be addressed and given intensive support.
OBJECTIVE: The worldwide incidence of pregnancy for women living with perinatal HIV infection is increasing. Subsequently, there is growing risk of second-generation mother-to-child HIV transmission. The infant clinical outcomes for such a phenomenon have yet to be described. DESIGN: As part of a wider observational study in KwaZulu-Natal, South Africa, six infants with in-utero HIV infection were identified as being born to mothers with perinatal HIV infection. METHODS: Blood results and clinical data were collected in the first 3 years of life. In two cases, sample availability allowed confirmation by phylogenetic analysis of grandmother-to-mother-to-child HIV transmission. RESULTS: Outcomes were poor in all six cases. All six mothers had difficulty administering twice daily combination antiretroviral therapy to their infants due to difficulties with acceptance, disclosure, poor health and being themselves long-term nonprogressors. Nonnucleoside reverse transcriptase inhibitor-resistant virus was detected in all mothers tested. None of the infants maintained suppression of viraemia on combination antiretroviral therapy. One infant died, and another was lost to follow-up. CONCLUSION: As the numbers of second-generation mother-to-child transmissions increase, it is important to highlight that this mother-infant dyad represents an extremely vulnerable group. In order for them to survive and thrive, these infants' mothers require their specific needs to be addressed and given intensive support.
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