AEGiS-13IAC: The influence of HIV-1 shedding in the genital tract and mother-to-child HIV infection.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

The influence of HIV-1 shedding in the genital tract and mother-to-child HIV infection.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. TuOrB353)

Mwanyumba F, Gaillard P, Verhofstede C, Schelfhout V, Claeys P, Chohan V, Deporter C, Mandaliya K, Temmerman M
F. Mwanyumba, Coast Provincial Hospital, PO Box 91109, Mombasa, Kenya, Tel.: +254 11 313 379, Fax: +254 11 474 055, E-mail: chlcpgh@africaonline.co.ke

BACKGROUND: The mechanism of HIV vertical transmission is unclear. It can occur in utero, through breast-feeding and at birth, possibly by contact with cervico-vaginal secretions. This study is based on the following working hypothesis: 1) Genital shedding increases the risk of perinatal infection of the infant, 2) placenta inflammation increases shedding of the virus into the genital tract and 3) placental inflammation increases the risk of mother to child transmission of HIV-1 (MCT).

METHODS: Prospective study to examine the effect of viral shedding and chorioamnionitis on MCT. Placental biopsies from HIV-1 positive mothers were processed for histological examination. Maternal Cervical-Vaginal Secretions (CVS) and infant's oro-pharyngeal secretions (OPS) were taken at birth and tested for HIV-1 by PCR methods. Infants' blood was collected at 48 hours and at 6 weeks after delivery for HIV-1 PCR. The correlation between placental inflammation, HIV shedding and maternal viral load was assessed along with maternal, obstetrical and infant characteristics. Finding: Between April 1998 and April 1999, 298 HIV positive mothers were recruited, and preliminary data are presented for 228 HIV positive women and their infants. HIV-1 DNA and HIV-1 RNA in CVS, and HIV-1 DNA in OPS were independently associated with maternal viral load. In OPS, presence of HIV-1 DNA is associated with maternal viral load. Intra-partum HIV transmission was independently associated with maternal log₁₀ viral load (95%CI = 1.0-2.7, p = 0.05), HIV-1 RNA in the CVS (95%CI = 1.5-7.3, p = 0.003) and HIV-1 DNA in the OPS (95%CI = 1.1-9.0, p = 0.03). HIV-1 DNA in OPS was also a risk factor for in utero transmission of HIV-1 (95%CI 1.3-7.2, p = 0.01). Placenta histology is in process. Interpretation: These preliminary results show an independent association between HIV-1 DNA in the maternal genital tract and the oral-pharyngeal cavity with perinatal HIV transmission, suggesting the oral route as one of the pathways of MCT of HIV.

Keywords: AEGIS, HIV-1, HIV Infections, Disease Transmission, Vertical, Viral Load, Virus Shedding, Risk Factors, Mothers, Breast Feeding, Prospective Studies, Vagina, Polymerase Chain Reaction, Chorioamnionitis, Delivery, Obstetric, Child, Infant, Human, Female, Pregnancy, transmission, virology, surgery
000709
TuOrB353