BACKGROUND: HIV-1 can be transmitted from an infected mother to her infant through breastfeeding, although the precise risk of transmission by this route is unknown. A long-term follow-up of children born to HIV-infected women in Abidjan, Côte d'Ivoire, has enabled us to estimate this risk. METHODS: Children born to 138 HIV-1-seropositive women, 132 HIV-2-seropositive women, 69 women seroreactive to both HIV-1 and HIV-2, and 274 HIV-seronegative women were enrolled at birth and followed up for as long as 48 months. All children were breastfed (median duration 20 months). Blood samples for either or both HIV PCR and HIV serology were obtained at 1, 2, and 3 months of age, and every 3 months thereafter. Early HIV infection was defined as a positive HIV-1 PCR result obtained in the first 6 months of life. Late postnatal transmission was diagnosed when a child had a negative PCR at 3 or 6 months of age, followed by either or both a positive HIV-1 PCR at 9 months or older, or persistently positive HIV-1 serology at 15 months or older. FINDINGS: 82 children born to HIV-1-seropositive mothers and 57 children born to mothers seropositive for both HIV-1 and HIV-2 had PCR results for samples taken within the first 6 months. By 6 months of age, 23 (28%; 95% CI 19-39) of the 82 children born to HIV-1-seropositive mothers and ten (18%; 95% CI 9-30) of the 57 children born to dually seropositive mothers were HIV-1 infected. Among children whose PCR results were negative at or before age 6 months, and who were followed up beyond 6 months, an additional four (9%) of the 45 children born to HIV-1-seropositive mothers and two (5%) of the 39 children born to dually seropositive mothers became HIV infected. The estimated rates of late postnatal transmission, with account taken of loss to follow-up and the observed pattern of weaning, were 12% (95% CI 3-23) and 6% (0-14), respectively. One of the five children whose mothers seroconverted from HIV-negative to HIV-1, and one of seven children whose mothers seroconverted from HIV-2 to dual reactivity, became HIV-1 positive. No case of late postnatal transmission occurred in children born to HIV-2-positive or persistently HIV-negative mothers. INTERPRETATION: Breastfed children born to mothers seropositive for HIV-1 alone or seropositive for HIV-1 and HIV-2 in Abidjan are at substantial risk of late postnatal transmission. Early cessation of breastfeeding at 6 months of age should be assessed as a possible intervention to reduce postnatal transmission of HIV.
BACKGROUND:HIV-1 can be transmitted from an infected mother to her infant through breastfeeding, although the precise risk of transmission by this route is unknown. A long-term follow-up of children born to HIV-infectedwomen in Abidjan, Côte d'Ivoire, has enabled us to estimate this risk. METHODS:Children born to 138 HIV-1-seropositivewomen, 132 HIV-2-seropositive women, 69 women seroreactive to both HIV-1 and HIV-2, and 274 HIV-seronegative women were enrolled at birth and followed up for as long as 48 months. All children were breastfed (median duration 20 months). Blood samples for either or both HIV PCR and HIV serology were obtained at 1, 2, and 3 months of age, and every 3 months thereafter. Early HIV infection was defined as a positive HIV-1 PCR result obtained in the first 6 months of life. Late postnatal transmission was diagnosed when a child had a negative PCR at 3 or 6 months of age, followed by either or both a positive HIV-1 PCR at 9 months or older, or persistently positive HIV-1 serology at 15 months or older. FINDINGS: 82 children born to HIV-1-seropositive mothers and 57 children born to mothers seropositive for both HIV-1 and HIV-2 had PCR results for samples taken within the first 6 months. By 6 months of age, 23 (28%; 95% CI 19-39) of the 82 children born to HIV-1-seropositive mothers and ten (18%; 95% CI 9-30) of the 57 children born to dually seropositive mothers were HIV-1 infected. Among children whose PCR results were negative at or before age 6 months, and who were followed up beyond 6 months, an additional four (9%) of the 45 children born to HIV-1-seropositive mothers and two (5%) of the 39 children born to dually seropositive mothers became HIV infected. The estimated rates of late postnatal transmission, with account taken of loss to follow-up and the observed pattern of weaning, were 12% (95% CI 3-23) and 6% (0-14), respectively. One of the five children whose mothers seroconverted from HIV-negative to HIV-1, and one of seven children whose mothers seroconverted from HIV-2 to dual reactivity, became HIV-1 positive. No case of late postnatal transmission occurred in children born to HIV-2-positive or persistently HIV-negative mothers. INTERPRETATION: Breastfed children born to mothers seropositive for HIV-1 alone or seropositive for HIV-1 and HIV-2 in Abidjan are at substantial risk of late postnatal transmission. Early cessation of breastfeeding at 6 months of age should be assessed as a possible intervention to reduce postnatal transmission of HIV.
Authors: P Msellati; N Meda; C Welffens-Ekra; V Leroy; P Van de Perre; L Mandelbrot; F Dabis Journal: Am J Public Health Date: 1999-06 Impact factor: 9.308
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Authors: Louise Kuhn; Hae-Young Kim; Jan Walter; Donald M Thea; Moses Sinkala; Mwiya Mwiya; Chipepo Kankasa; Don Decker; Grace M Aldrovandi Journal: Sci Transl Med Date: 2013-04-17 Impact factor: 17.956
Authors: Grace John-Stewart; Dorothy Mbori-Ngacha; Rene Ekpini; Edward N Janoff; John Nkengasong; Jennifer S Read; Phillippe Van de Perre; Marie-Louise Newell Journal: J Acquir Immune Defic Syndr Date: 2004-02-01 Impact factor: 3.731
Authors: Yvonne Owens Ferguson; Eugenia Eng; Margaret Bentley; Margarete Sandelowski; Allan Steckler; Elizabeth Randall-David; Ellen G Piwoz; Cynthia Zulu; Charles Chasela; Alice Soko; Martin Tembo; Francis Martinson; Beth Carlton Tohill; Yusuf Ahmed; Peter Kazembe; Denise J Jamieson; Charles van der Horst; Linda Adair; Yusuf Ahmed; Mounir Ait-Khaled; Sandra Albrecht; Shrikant Bangdiwala; Ronald Bayer; Margaret Bentley; Brian Bramson; Emily Bobrow; Nicola Boyle; Sal Butera; Charles Chasela; Charity Chavula; Joseph Chimerang'ambe; Maggie Chigwenembe; Maria Chikasema; Norah Chikhungu; David Chilongozi; Grace Chiudzu; Lenesi Chome; Anne Cole; Amanda Corbett; Amy Corneli; Ann Duerr; Henry Eliya; Sascha Ellington; Joseph Eron; Sherry Farr; Yvonne Owens Ferguson; Susan Fiscus; Shannon Galvin; Laura Guay; Chad Heilig; Irving Hoffman; Elizabeth Hooten; Mina Hosseinipour; Michael Hudgens; Stacy Hurst; Lisa Hyde; Denise Jamieson; George Joaki; David Jones; Zebrone Kacheche; Esmie Kamanga; Gift Kamanga; Coxcilly Kampani; Portia Kamthunzi; Deborah Kamwendo; Cecilia Kanyama; Angela Kashuba; Damson Kathyola; Dumbani Kayira; Peter Kazembe; Rodney Knight; Athena Kourtis; Robert Krysiak; Jacob Kumwenda; Edde Loeliger; Misheck Luhanga; Victor Madhlopa; Maganizo Majawa; Alice Maida; Cheryl Marcus; Francis Martinson; Navdeep Thoofer; Chrissie Matika; Douglas Mayers; Isabel Mayuni; Marita McDonough; Joyce Meme; Ceppie Merry; Khama Mita; Chimwemwe Mkomawanthu; Gertrude Mndala; Ibrahim Mndala; Agnes Moses; Albans Msika; Wezi Msungama; Beatrice Mtimuni; Jane Muita; Noel Mumba; Bonface Musis; Charles Mwansambo; Gerald Mwapasa; Jacqueline Nkhoma; Richard Pendame; Ellen Piwoz; Byron Raines; Zane Ramdas; John Rublein; Mairin Ryan; Ian Sanne; Christopher Sellers; Diane Shugars; Dorothy Sichali; Wendy Snowden; Alice Soko; Allison Spensley; Jean-Marc Steens; Gerald Tegha; Martin Tembo; Roshan Thomas; Hsiao-Chuan Tien; Beth Tohill; Charles van der Horst; Esther Waalberg; Jeffrey Wiener; Cathy Wilfert; Patricia Wiyo; Onnocent Zgambo; Chifundo Zimba Journal: AIDS Educ Prev Date: 2009-04