AEGiS-15IAC: Maternal and infant viral load impact disease progression in HIV-1 infected African infants.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Maternal and infant viral load impact disease progression in HIV-1 infected African infants.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. TuOrB1187)

Obimbo EM, Mbori-Ngacha DA, Overbaugh J, Emery S, Otieno PA, Wamalwa D, Gichuhi C, Wariua G, Bosire R, Lohman B, John-Stewart G
University of Nairobi, Nairobi, Kenya

BACKGROUND: We conducted a prospective observational study in Nairobi among HIV-1 infected pregnant women and their infants to determine association between maternal and infant viral burden, and infant disease progression.

METHODS: HIV-1 infected women were enrolled during third trimester and given short course zidovudine for prevention of vertical transmission. Infants identified by HIV-1 DNA PCR to be infected were followed to age 2 years or death. Plasma RNA viral load (VL) was determined during pregnancy for mothers, and at birth, 1 month and thereafter quarterly for infants.

RESULTS: Seventy-nine infants became HIV-1 infected, with 29%, 57% and 14% of infections occurring in-utero, peri-partum and late post-partum respectively. Their mothers were of median age 25 years (range 18-38), median CD4 count 371 (range 6-880), median VL 154,295 copies/ml (range 840-2,203,300), and 81% took zidovudine prophylaxis during pregnancy. Infants were born at median gestation 40 weeks (33-42), median birth weight 3.1 kg (1.9-4.0), 12% were born premature, 53% were male, 84% breastfed, and 49% died during follow-up at a median age of 7.3 months (1.3-24.5). Median peak VL of the infants was 5,622,300 c/ml (range 68,348-270,000,000) and median VL set point was 1,251,450 c/ml (19,220-89,000,000). In unadjusted survival analyses maternal VL >median (HR=2.4, P=.002), birth weight<2.5kg (HR=4.8, P<.001), infant peak VL >median (HR=1.7, P=.02), infant VL at month 3 >median (HR=2.0, P=.009), infant CD4 count<750 cells/ml and CD4<15% at month 6 (HR=7.4, P<.001 and HR=5.6, P=.005 respectively) were associated with death before age 2 years. In adjusted analyses, maternal VL (HR=2.1, P=.03), infant peak VL (HR=1.9, P=.02) and low birth weight (HR=6.4, P<.001) were independently associated with early death.

CONCLUSIONS: High maternal VL, high infant peak VL and low birth weight are predictive of death before age 2 years in this cohort of African HIV-1 infected infants.

Keywords: AEGIS, Viral Load, HIV-1, Disease Progression, Disease Transmission, Vertical, CD4 Lymphocyte Count, Zidovudine, Mothers, Pregnancy Complications, Infectious, Prospective Studies, Polymerase Chain Reaction, Birth Weight, Infection, Infant, Humans, Female, Pregnancy, Male, transmission

040711
TuOrB1187