In utero and intra-partum HIV-1 transmission and acute HIV-1 infection during pregnancy: Using the BED capture enzyme-immunoassay as a surrogate marker for acute infection

ZVITAMBO Project, Harare, Zimbabwe.
International Journal of Epidemiology (Impact Factor: 9.18). 04/2011; 40(4):945-54. DOI: 10.1093/ije/dyr055
Source: PubMed


The BED assay was developed to estimate the proportion of recent HIV infections in a population. We used the BED assay as a proxy for acute infection to quantify the associated risk of mother-to-child-transmission (MTCT) during pregnancy and delivery. Design A total of 3773 HIV-1 sero-positive women were tested within 96 h of delivery using the BED assay, and CD4 cell count measurements were taken. Mothers were classified according to their likelihood of having recently seroconverted.
The risk of MTCT in utero and intra-partum was assessed comparing different groups defined by BED and CD4 cell count, adjusting for background factors using multinomial logistic models.
Compared with women with BED ≥ 0.8/CD4 ≥ 350 (typical of HIV-1 chronic patients) there was insufficient evidence to conclude that women presenting with BED < 0.8/CD4 ≥ 350 (typical of recent infections) were more likely to transmit in utero [adjusted odds ratio (aOR) = 1.37, 96% confidence interval (CI) 0.90-2.08, P = 0.14], whereas women with BED < 0.8/CD4 200-349 (possibly recently infected patients) had a 2.57 (95% CI 1.39-4.77, P-value < 0.01) odds of transmitting in utero. Women who had BED < 0.8/CD4 < 200 were most likely to transmit in utero (aOR 3.73, 95% CI 1.27-10.96, P = 0.02). BED and CD4 cell count were not predictive of intra-partum infections.
These data provide evidence that in utero transmission of HIV might be higher among women who seroconvert during pregnancy.

Download full-text


Available from: Robert Ntozini
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Identification of recent HIV-infections is important for describing the HIV epidemic and compiling HIV-RNA-setpoint data for future HIV intervention trials. We conducted a study to characterize recent infections, and HIV-RNA-setpoint within the adult population presenting at a voluntary counselling and testing centre (VCT) in southern Mozambique. All adults attending the Manhiça District-Hospital VCT between April and October 2009 were recruited if they had at least one positive rapid HIV-serology test. Patients were screened for recent HIV-1 infection by BED-CEIA HIV-incidence test. Clinical examination, assessment of HIV-RNA and CD4 cell counts were performed at enrollment, 4 and 10 months. Of the 492 participants included in this study, the prevalence of recent infections as defined by BED-CEIA test, CD4 counts >200 cells/µl and HIV-RNA >400 copies/mL, was 11.58% (57/492; 95% CI 8.89-14.74). Due to heterogeneity in HIV-RNA levels in recently infected patients, individuals were categorized as having "high" HIV-RNA load if their HIV-RNA level was above the median (4.98 log(10) copies/mL) at diagnosis. The "high" HIV-RNA group sustained a significantly higher HIV-viral load at all visits with a median HIV-RNA setpoint of 5.22 log(10) copies/mL (IQR 5.18-5.47) as compared to the median of 4.15 log(10) copies/ml (IQR 3.37-4.43) for the other patients (p = 0.0001). The low proportion of recent HIV-infections among HIV-seropositive VCT clients suggests that most of this population attends the VCT at later stages of HIV/AIDS. Characterization of HIV-RNA-setpoint may serve to identify recently infected individuals maintaining HIV viral load>5 log10 copies/mL as candidates for antiretroviral treatment as prevention interventions.
    Full-text · Article · Feb 2012 · PLoS ONE
  • [Show abstract] [Hide abstract]
    ABSTRACT: Pregnant women have a significantly higher risk of HIV acquisition during gestation than their non-pregnant counterparts due to behavioral and biological factors. Acute seroconversion during gestation results in increased HIV mother-to-child transmission rates and has been identified as a major public health challenge. In order to address potential HIV seroconversion in our pregnant patients, we conducted a prospective cohort study to evaluate the acceptability of offering HIV testing to sexual partners of HIV-negative pregnant women receiving antenatal care at two hospitals in Porto Alegre, Brazil. Over a 14-month study period, HIV-negative pregnant women at two hospital-based clinic sites were encouraged to bring their stable sexual partner for HIV voluntary counseling and testing during prenatal care. Women were re-interviewed following delivery to measure success of the intervention. Of the 1223 HIV-negative pregnant women enrolled in the study, 663 (54%) of their male sexual partners received HIV testing during antenatal care and 4 (0.6%) were diagnosed with HIV infection. A total of 645 women were interviewed at the time of delivery, with 620 (97%) confirming that HIV testing was suggested to their partner. The most common reason provided by women as to why partners did not come for testing was work (69%) and lack of perceived risk (14%). Independent predictors of successful partner testing included being white (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.18-2.12), married (OR 1.78, 95% CI 1.08-2.94), having an older age of sexual debut (OR 0.94, 95% CI 0.9-0.98), and being recruited at Hospital Conceiçao (OR 2.1, 95% CI 1.52-2.88). We conclude that HIV partner testing during prenatal care is acceptable, rendering this intervention attractive to public health programs targeting prevention of sexually transmitted infections.
    No preview · Article · Nov 2013 · AIDS Care
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: RESUMO-Objetivo: avaliar as evidências disponíveis nos artigos científicos acerca dos fatores que interferem na transmissão vertical do HIV. Método: Trata-se de uma revisão integrativa da literatura, com a seguinte questão de pesquisa: quais são os fatores que interferem na transmissão vertical do HIV? A busca foi desenvolvida em janeiro de 2014 na base de dados LILACS, IBECS, MEDLINE, PubMed, Web of Science e Scopus com descritores " HIV " and " Transmissão Vertical de Doença Infecciosa " and " Fatores de Risco " , o recorte temporal foi entre 2009 e 2013. Resultados: 24 artigos de pesquisa evidenciaram fatores de risco clínicos e imunológico, da nutrição materna, obstétricos, do uso de antirretrovirais, relacionados ao recém-nascido, comporta-mento e fatores protetores, profilaxia para o recém-nascido, regimes de terapia durante seis meses após o parto, alimentação do recém-nascido. Conclusão: Os fatores de risco e de proteção podem ser associados ou independentes entre si, de modo que para a redução das taxas de transmissão vertical devem ser realizadas ações que visem identificar estes fatores de modo a minimizar os riscos e promover a proteção do recém-nascido exposto. Descritores: HIV; transmissão vertical de doença infecciosa; síndrome da imunodeficiência adquirida; fatores de risco. ABSTRACT-Aim: to evaluate evidence available on scientific articles about factors that interfere on vertical transmission of HIV. Methods: It is an integrative literature review with the following research question: what are the factors that interfere on vertical transmission of HIV? Search was developed on January 2014 on databases LILACS, IBECS, MEDLINE, PubMed, Web of Science and Scopus with descriptors " HIV " and " " and " Risk Factors " , timeframe was between 2009 and 2013. Results: 24 research articles that evidenced risk factors that are clinical and immunological, of a mother's nutrition, obstetric, of antiretroviral use, related to newborns, behavior and protecting factors, prophylaxis for the newborn, therapy regimes during six months after delivery, newborn's nutrition. Conclusions: Risk and protecting factors can be associated or independent among themselves, in order to reduce rates of vertical transmission it is necessary to perform actions that aim to identify these factors to minimize risks and promote protection for the exposed newborn. Descriptors: HIV; infectious disease vertical transmission; acquired immunodeficiency syndrome; risk factors. RESUMEN-Objetivo: evaluar las evidencias disponibles en los artículos científicos acercas de los factores que influyen en la trans-misión vertical del VIH. Método: Se trata de una revisión integradora de la literatura, con la siguiente question de investigación: ¿cuáles son los factores que interfieren en la transmisión vertical del VIH? La búsqueda se realizó en enero de 2014 en la base de datos LILACS, IBECS, MEDLINE, PubMed, Web of Science e Scopus com palabras clave " VIH " and " Transmissão Vertical de Doença Infecciosa " and " Fatores de Risco " , el período de tiempo fue entre 2009 e 2013. Resultados: 24 artículos de investigación mostraron factores clínicos e inmunológicos de riesgo, de la nutrición materna, obstétrica, de uso de antirretrovirales, relacionados con el recién nacido, comportamiento y los factores de protección, profilaxis para el recién nacido, regímenes de terapia durante seis meses después del nacimiento, la alimentación del recién nacido. Conclusión: Los factores de riesgo y de protección pueden ser asociados o independientes entre si, de modo que para la reducción de las taxas de transmisión vertical se deben realizadar acciones dirigidas a identificar estos factores para minimizar los riesgos y promover la proteçción del recién nacido expuesto. Descriptores: VIH; transmisión vertical de enfermedad infecciosa;síndrome de inmunodeficiencia adquirida; factores de riesgo. Fatores que interferem na transmissão vertical do HIV: revisão integrativa Risk factors that interfere on vertical transmission of HIV: integrative review Factores de riesgo que afectan a la transmisión vertical del VIH: revisión integradora
    Full-text · Article · Jan 2014