ArticlesLate postnatal mother-to-child transmission of HIV-1 in Abidjan, Côte d'lvoire
Introduction
HIV-1 can be transmitted from an infected mother to her offspring during pregnancy (in utero), during labour and delivery (intrapartum), and after delivery.1 There is substantial evidence that postnatal transmission of HIV-1 occurs predominantly through breastfeeding. Not only has HIV-1 been detected in human breastmilk by viral culture,2 but also mother-to-child transmission of HIV-1 has occurred among breastfeeding women who acquired HIV after delivery.3, 4, 5 In several studies of mother-to-child transmission, moreover, a higher proportion of breastfed than formula-fed children were HIV infected at the end of follow-up.69 To estimate the risk of HIV transmission through breastfeeding from these reports is difficult owing to the small number of breastfeeding women studied, and the varied methods used. However, from a meta-analysis of such reports, this risk has been estimated at 14% for children born to mothers who were seropositive before delivery, and 29% for children born to mothers infected postnatally.10 But the risk of transmission through breastfeeding has not been well characterised. To distinguish postnatal transmission from in-utero or intra-partum transmission more reliably, a defined population of children born to seropositive mothers must be studied by means of virological techniques, such as PCR testing.
Accurate estimates of the risk of HIV-1 transmission through breastfeeding would allow public-health authorities to improve breastfeeding guidelines for HIV-infected women. Such an estimate would also help in the evaluation of interventions currently being investigated to prevent perinatal transmission of HIV-1 in breastfeeding populations. In this study, we assessed the rate of late postnatal mother-to-child HIV transmission among breastfed children in Abidjan, Côte ďIvoire.
Section snippets
Selection of participants and follow-up
Data for this analysis were collected from September, 1990 to October, 1994 in Abidjan, Côte ďIvoire. The study methods and transmission rates among a subset of the cohort have been reported previously.11 Women were screened for HIV-1 and HIV-2 antibodies at delivery. All women residing in Abidjan whose serum was positive for antibodies to HIV-2 or to both HIV-1 and HIV-2 were asked to enrol, as were selected women who were positive for HIV-1 antibody or negative for HIV antibody. Each child
Results
613 mother-child pairs were enrolled. The median follow-up of this population was 27 months, and ranged from 1 to 48 months for all children, and from 30 to 48 months for children who were not lost to follow-up and did not die. All children were breastfed; among children followed up for at least 24 months, the median duration of breastfeeding was 20 months (range 6–33 months). Three HIV-2-seropositive and three HIV-negative women gave birth to twins; these children are excluded from further
Discussion
This study found that 12% of breastfed children of HIV-1-seropositive mothers who escape HIV infection during the first 6 months of life will become HIV infected by 24 months of age. Moreover, among children who escape early infection and who are breastfed until age 24 months, 20% will acquire HIV infection by that age. 28% of children acquired HIV infection in the first 6 months of life. The transmission rates were lower for children born to mothers seropositive for both HIV-1 and HIV-2, but
References (20)
- et al.
Isolation of AIDS virus from cell-free breast milk of three healthy virus carriers
Lancet
(1985) - et al.
Postnatal transmission of AIDS-associated retrovirus
Lancet
(1985) - et al.
Risk of human immunodeficiency virus type 1 transmission through breastfeeding
Lancet
(1992) - et al.
Prevalence of HIV-1 and HIV-2 mixed infections in Côte ďIvoire
Lancet
(1992) - et al.
Maternal-fetal transmission of human immunodeficiency virus: a review of possible routes and cellular mechanisms of infection
Clin Infect Dis
(1992) - et al.
Postnatal transmission of human immunodeficiency virus type 1 from mother to infant: a prospective cohort study in Kigali, Rwanda
N Engl J Med
(1991) - et al.
Breast-feeding during primary maternal human immunodeficiency virus infection and risk of transmission from mother to infant
J Infect Dis
(1993) - et al.
Prospective comparison of HIV-1 and HIV-2 perinatal transmission in Abidjan, Ivory Coast
JAMA
(1994) - et al.
Rapid and specific diagnosis of HIV-1 and HIV-2 infections: an evaluation of testing strategies
AIDS
(1990) - et al.
Order restricted statistical inference
(1988)
Cited by (142)
Viruses and Human Milk: Transmission or Protection?
2023, Advances in NutritionMother-to-child transmission of HIV-1 and infant mortality in the first six months of life, in the era of Option B Plus combination antiretroviral therapy
2021, International Journal of Infectious DiseasesCitation Excerpt :Indeed, a study conducted in France reported zero MTCT in HIV-infected women who were on cART with an undetectable VL before conception and who continued cART throughout pregnancy and had an undetectable VL at delivery (Mandelbrot et al., 2015). Prior to the introduction of cART for PMTCT, one-third to one-half of PP transmission in sub-Saharan Africa was attributable to breastfeeding (Ekpini et al., 1997; Miotti et al., 1999; Nduati et al., 2000; Van der Perre et al., 1991). Breastfeeding, mostly in the form of mixed feeding, is widely practised in sub-Saharan Africa.
Viral, Protozoan, and Related Intracranial Infections
2018, Volpe's Neurology of the NewbornEpidemiology and Prevention of HIV Infection in Children and Adolescents
2018, Principles and Practice of Pediatric Infectious DiseasesEpidemiology and Prevention of HIV Infection in Children and Adolescents
2012, Principles and Practice of Pediatric Infectious Diseases, Fourth EditionNeonatal Infections: A Global Perspective
2011, Infectious Diseases of the Fetus and Newborn Infant