Maternal risk factors for HIV infection in infants in northeastern Brazil

Lemos, Lígia Mara Dolce de; Lippi, Joseph; Rutherford, George W.; Duarte, G; Martins, Nágyla Galvão Regis; Santos, Victor Santana; Gurgel, Ricardo Queiróz

doi:10.1016/j.ijid.2013.04.015

Cited by 25 publications

(23 citation statements)

References 29 publications

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“…The observed risk difference could be due to the reason that ARV prophylaxis for exposed infants decreases vertical transmission of the virus from HIV positive mothers. This finding is in tune with studies conducted in Brazil and Ethiopia [20,25,26,30].…”

Section: Discussionsupporting

confidence: 90%

“…A possible explanation for this might be that the study conducted in Brazil was a 21 years study, which started when PMTCT program wasn't as efficient and modernized as recently. Our finding was also less than Ethiopia's national estimate of MTCT in 2013 and 2015 and from studies done in Arsi add Dire Dawa, Ethiopia [9,12,13,20,25]. This may be explained by the reason that no mixed feeding was practiced in our study, which enhances the odds of HIV positivity.…”

Section: Discussioncontrasting

confidence: 79%

“…Pertaining to the factors for HIV positivity of exposed infants, different studies reported various determinants. Accordingly, mothers with high viral load, symptomatic disease, failure to use ARV drugs during pregnancy, vaginal delivery, rupture of membrane > 4 h, low birth weight babies, premature births, and infants' failure to use Antiretroviral (ARV) prophylaxis were found to be associated with HIV positivity among infants [18][19][20].…”

Section: Introductionmentioning

confidence: 99%

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HIV testing, test results and factors influencing among infants born to HIV positive mothers in public hospitals of Mekelle City, North Ethiopia: a cross-sectional study

2020

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Background: Timely infant testing for HIV is critical to ensure optimal treatment outcomes among exposed infants. While world health organization recommends HIV exposed infants to be tested between 4 to 6 weeks of age, in developing countries like Ethiopia, access to timely infant testing is still very limited. The study is intended to assess timely infant testing, testing for HIV at the 18th month, test results and factors influencing HIV positivity among infants born to HIV positive mothers in public hospitals of Mekelle, Ethiopia. Methods:A cross-sectional study design was employed on 558 HIV exposed infants, using consecutive sampling technique. A checklist was used to extract 4 years (Data were analyzed using SPSS version 20, and binary logistic regression model was used to examine the association of independent variables with the outcome variables. Results: Timely infant testing for HIV accounted for 346(62.0%). Mothers who attended antenatal care (AOR: 2.77; 95% CI: 1.17, 6.55) and who were counselled on feeding options (AOR: 2.01; 95% CI: 1.11, 3.65) were strongly associated with timely infant testing. Poor maternal adherence status was associated with infants' HIV positivity at the 18th month of antibody test (AOR: 15.93; 95% CI: 2.21, 94.66). Being rural resident (AOR: 4.0; 95% CI: 1.23, 13.04), being low birth weight (AOR: 5.64; 95% CI: 2.00, 16.71) and not receiving ARV prophylaxis (AOR: 4.70; 95% CI: 1.15, 19.11) were positively associated with the overall HIV positivity. Conclusions: A considerable proportion of exposed infants did not undergo timely testing for HIV. Antenatal care follow-up and counselling on feeding options were associated with timely infant testing. Mother's poor adherence status was associated with infant's HIV positivity at the 18th month of antibody testing. Being rural resident, being low birth weight, and not receiving ARV prophylaxis were the factors that enhance the overall HIV positivity. Timely infant testing, counselling on feeding options and adherence should be intensified, and prevention of mother-tochild transmission program in rural settings need to be strengthened.

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Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

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HIV testing, test results and factors influencing among infants born to HIV positive mothers in public hospitals of Mekelle City, North Ethiopia: a cross-sectional study

2020

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“…Established major maternal risk factors of vertical HIV transmission include plasma viral load levels, peripheral CD4 ϩ T cell count, delivery mode (caesarean section versus vaginal delivery), and infant gestational age at ART initiation (6)(7)(8)(9)(10). However, despite these risk factors, in the absence of ART, only up to 40% of HIV-infected women transmit the virus to their infants.…”

Section: Importancementioning

confidence: 99%

Maternal Binding and Neutralizing IgG Responses Targeting the C-Terminal Region of the V3 Loop Are Predictive of Reduced Peripartum HIV-1 Transmission Risk

Martinez

Vandergrift²,

Douglas³

et al. 2017

J Virol

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The development of an effective maternal HIV-1 vaccine that could synergize with antiretroviral therapy (ART) to eliminate pediatric HIV-1 infection will require the characterization of maternal immune responses capable of blocking transmission of autologous HIV to the infant. We previously determined that maternal plasma antibody binding to linear epitopes within the variable loop 3 (V3) region of HIV envelope (Env) and neutralizing responses against easy-to-neutralize tier 1 viruses were associated with reduced risk of peripartum HIV infection in the historic U.S. Woman and Infant Transmission Study (WITS) cohort. Here, we defined the fine specificity and function of the potentially protective maternal V3-specific IgG antibodies associated with reduced peripartum HIV transmission risk in this cohort. The V3-specific IgG binding that predicted low risk of mother-to-child-transmission (MTCT) was dependent on the C-terminal flank of the V3 crown and particularly on amino acid position 317, a residue that has also been associated with breakthrough transmission in the RV144 vaccine trial. Remarkably, the fine specificity of potentially protective maternal plasma V3-specific tier 1 virus-neutralizing responses was dependent on the same region in the V3 loop. Our findings suggest that MTCT risk is associated with neutralizing maternal IgG that targets amino acid residues in the C-terminal region of the V3 loop crown, suggesting the importance of the region in immunogen design for maternal vaccines to prevent MTCT. IMPORTANCE Efforts to curb HIV-1 transmission in pediatric populations by antiretroviral therapy (ART) have been highly successful in both developed and developing countries. However, more than 150,000 infants continue to be infected each year, likely due to a combination of late maternal HIV diagnosis, lack of ART access or adherence, and drug-resistant viral strains. Defining the fine specificity of maternal humoral responses that partially protect against MTCT of HIV is required to inform the development of a maternal HIV vaccine that will enhance these responses during pregnancy. In this study, we identified amino acid residues targeted by potentially protective maternal V3-specific IgG binding and neutralizing responses, localizing the potentially protective response in the C-terminal region of the V3 loop crown. Our findings have important implications for the design of maternal vaccination strategies that could synergize with ART during pregnancy to achieve the elimination of pediatric HIV infections.KEYWORDS HIV, mother-to-child transmission, V3, antibodies

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“…The estimated HIV prevalence among women attending antenatal clinics is 0.42% (8) . Among children < 5 years old, the incidence of AIDS has decreased considerably in recent years from 2.75 cases per 100,000 per year in 2005 to 0.6 cases per 100,000 per year in 2011 (9) .…”

Section: Late Diagnosis Of Human Immunodefi Ciency Virus (Hiv)mentioning

confidence: 99%

Prevalence of and risk factors for late diagnosis of HIV infection in Brazilian infants and children

Lemos

Anglemyer²,

Santos

et al. 2015

Rev. Soc. Bras. Med. Trop.

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Introduction: Late human immunodefi ciency virus (HIV) diagnosis is an important cause of HIV-related morbidity and mortality in infants and children. Methods: This retrospective cohort study of HIV-infected children diagnosed in Sergipe, in northeastern Brazil, between 2002 and 2011 aimed to determine the prevalence of and risk factors for late HIV diagnosis. Results: Of 55 infants and children with confi rmed infection, 42 (76.5%) were diagnosed at ≥ 12 months old. No antiretroviral prophylaxis during delivery (OR 5.48,) was associated with late diagnosis. Conclusions: More than 75% of cases were diagnosed late. Efforts are needed to improve early HIV diagnosis in infants.

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Maternal risk factors for HIV infection in infants in northeastern Brazil

Cited by 25 publications

References 29 publications

HIV testing, test results and factors influencing among infants born to HIV positive mothers in public hospitals of Mekelle City, North Ethiopia: a cross-sectional study

HIV testing, test results and factors influencing among infants born to HIV positive mothers in public hospitals of Mekelle City, North Ethiopia: a cross-sectional study

Maternal Binding and Neutralizing IgG Responses Targeting the C-Terminal Region of the V3 Loop Are Predictive of Reduced Peripartum HIV-1 Transmission Risk

Prevalence of and risk factors for late diagnosis of HIV infection in Brazilian infants and children

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