Exposure to HIV-1 during delivery and mother-to-child transmission

• Published in: AIDS (London) Vol. 14; no. 15; pp. 2341 - 2348
• Main Authors: GAILLARD, Philippe, VERHOFSTEDE, Chris, MWANYUMBA, Fabian, CLAEYS, Patricia, CHOHAN, Varsha, MANDALIYA, Kishorchandra, BWAYO, Job, PLUM, Jean, TEMMERMAN, Marleen
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 20.10.2000
• Subjects: AIDS/HIV; Biological and medical sciences; Bodily Secretions - virology; Cohort Studies; Female; Genitalia, Female - virology; HIV Infections - transmission; HIV-1; Human immunodeficiency virus 1; Human viral diseases; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Infectious diseases; Kenya; Medical sciences; Oropharynx - virology; Polymerase Chain Reaction; Tropical medicine; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Virus Shedding; Kenya; Africa; Human; Immunopathology; HIV-1 virus; Retroviridae; AIDS; Maternal diseases; Immune deficiency; Lentivirus; Mechanism; Infection; Virus; Mother; Viral disease; Risk factor; Vertical transmission; Birth weight; Human immunodeficiency virus; Delivery; Viral load; Child
• ISSN: 0269-9370; 1473-5571
• DOI: 10.1097/00002030-200010200-00015

The correlation between the presence of HIV-1 in maternal cervicovaginal secretions and in the infant's oro-pharyngal secretions at birth, and mother-to-child HIV transmission (MTCT) were examined to obtain a better understanding of its mechanism. Women without medical and obstetrical complications, living within a reasonable distance of the government hospital in Mombasa, Kenya, were recruited after informed consent. Maternal and infant characteristics were collected. Polymerase chain reaction was used to detect HIV-1 in cervico-vaginal and oro-pharyngal secretions. Infants were tested for HIV-1 by polymerase chain reaction within 48 h and at 6 weeks after delivery. Between April 1998 and April 1999, 228 woman-infant pairs were included in the study. HIV-1 DNA in cervico-vaginal secretions was independently associated with HIV-1 maternal viral load and with infant birth-weight, whereas HIV-1 RNA was associated with maternal viral load and maternal age. HIV-1 DNA in the oropharyngal secretions was also independently associated with maternal viral load. MTCT rate at the age of 6 weeks was 23.6%. Intrapartum and early postpartum HIV transmission was independently associated with maternal viral load [adjusted odds ratio (OR), 1.6; 95% confidence interval (CI),1.0-2.7], detection of HIV-1 RNA in cervico-vaginal secretions (adjusted OR, 3.2; 95% CI, 1.5-7.3) and of HIV-1 DNA in oro-pharyngeal secretions (adjusted OR, 3.2; 95% CI, 1.1-9.0). As far as is known, this is the first study showing that infant exposure to HIV-1 in the birth canal and the presence of HIV-infected cells in the infant's oropharyngeal cavity are independently associated with intrapartum and early postpartum MTCT. It supports the hypothesis that MTCT could occur through the oral route.