alexa Impact of Maternal HIV Seroconversion during Pregnancy on Early Mother to Child Transmission of HIV (MTCT) Measured at 4-8 Weeks Postpartum in South Africa 2011-2012: A National Population-Based Evaluation.
Pulmonology

Pulmonology

Journal of Pulmonary & Respiratory Medicine

Author(s): Dinh TH, Delaney KP, Goga A, Jackson D, Lombard C,

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Abstract BACKGROUND: Mother-to-child transmission of HIV (MTCT) depends on the timing of HIV infection. We estimated HIV-seroconversion during pregnancy (HSP) after having a HIV-negative result antenatally, and its contribution to early MTCT in South Africa (SA). METHODS AND FINDINGS: Between August 2011 and March 2012, we recruited a nationally representative sample of mother-infant pairs with infants aged 4-to-8 weeks from 578 health facilities. Data collection included mother interviews, child health-card reviews, and infant dried-blood-spots sample (iDBS). iDBS were tested for HIV antibodies and HIV-deoxyribonucleic-acid (HIV-DNA). HSP was defined as maternal self-report of an HIV-negative test during this pregnancy, no documented use of antiretroviral drugs and a matched HIV sero-positive iDBS. We used 20 imputations from a uniform distribution for time from reported antenatal HIV-negative result to delivery to estimate time of HSP. Early MTCT was defined based on detection of HIV-DNA in iDBS. Estimates were adjusted for clustering, nonresponse, and weighted by SA's 2011 live-births. RESULTS: Of 9802 mother-infant pairs, 2738 iDBS were HIV sero-positive, including 212 HSP, resulting in a nationally weighted estimate of 3.3\% HSP (95\% Confidence Interval: 2.8\%-3.8\%). Median time of HIV-seroconversion was 32.8weeks gestation;28.3\% (19.7\%- 36.9\%) estimated to be >36 weeks. Early MTCT was 10.7\% for HSP (6.2\%-16.8\%) vs. 2.2\% (1.7\%-2.8\%) for mothers with known HIV-positive status. Although they represent 2.2\% of all mothers and 6.7\% of HIV-infected mothers, HSP accounted for 26\% of early MTCT. Multivariable analysis indicated the highest risk for HSP was among women who knew the baby's father was HIV-infected (adjusted-hazard ratio (aHR) 4.71; 1.49-14.99), or who had been screened for tuberculosis (aHR 1.82; 1.43-2.32). CONCLUSIONS: HSP risk is high and contributes significantly to early MTCT. Identification of HSP by repeat-testing at 32 weeks gestation, during labor, 6 weeks postpartum, in tuberculosis-exposed women, and in discordant couples might reduce MTCT.
This article was published in PLoS One and referenced in Journal of Pulmonary & Respiratory Medicine

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