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Multicenter Study
. 2010 Jul;54(3):311-6.
doi: 10.1097/QAI.0b013e3181d61c2e.

Population attributable fractions for late postnatal mother-to-child transmission of HIV-1 in Sub-Saharan Africa

Ying Q Chen  1 , Alicia Young, Elizabeth R Brown, Charles S Chasela, Susan A Fiscus, Irving F Hoffman, Megan Valentine, Lynda Emel, Taha E Taha, Robert L Goldenberg, Jennifer S Read
Affiliations
Multicenter Study

Population attributable fractions for late postnatal mother-to-child transmission of HIV-1 in Sub-Saharan Africa

Ying Q Chen et al. J Acquir Immune Defic Syndr. 2010 Jul.

Abstract

Objectives: Assess population attributable fractions (PAFs) for late postnatal transmission (LPT) of HIV-1 in a cohort of HIV-1-exposed infants.

Methods: We used data established from a risk factor analysis of LPT (negative HIV-1 results through the 4-6 week visit, but positive assays thereafter through the 12-month visit) from a perinatal clinical trial conducted in 3 sub-Saharan countries. PAFs were calculated as the proportions of excess LPTs attributed to identified risk factors.

Results: For the cohort of 1317 infants, 206 (15.6%) had only low maternal CD4 counts (<200 cells/mm), 332 (25.2%) had only high maternal plasma viral loads (VLs) (>50,000 copies/mL), and 81 (6.2%) had both low CD4 counts and high VLs. Their PAFs were 26.0% [95% confidence interval (CI): 12.0% to 36.0%], 37.0% (95% CI: 22.0% to 51.0%), and 16.0% (95% CI: 6.0% to 25.0%), respectively.

Conclusions: Our PAF analysis illustrates the public health impact of the substantial proportion of LPTs accounted for by high-risk women with both low CD4 counts and high VLs. In light of these results, access to and use of antiretroviral therapy by high-risk HIV-1-infected pregnant women is essential. Additional strategies to reduce LPT for those not meeting criteria for antiretroviral therapy should be implemented.

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Figures

Figure 1
Figure 1
Scatter plot of maternal viral loads (log10 copies/ml) versus maternal CD4+ counts (cells/mm^3)
Figure 2
Figure 2
Kaplan–Meier Estimates for Proportion of HIV–1 Uninfected Infants During the Late Postnatal Period
See this image and copyright information in PMC

References

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