Skip Navigation LinksHome > January 2, 2004 - Volume 18 - Issue 1 > Maternal viral load and rate of disease progression among ve...
Epidemiology & Social

Maternal viral load and rate of disease progression among vertically HIV-1-infected children: an international meta-analysis

Ioannidis, John PAa,b,c; Tatsioni, Athinaa; Abrams, Elaine Jd; Bulterys, Marce; Coombs, Robert Wf; Goedert, James Jg; Korber, Bette Th,i; Mayaux, Marie Jeannej; Mofenson, Lynne Mk; Moye, Jr, Jackk; Newell, Marie-Louisel; Shapiro, David Em; Teglas, Jean Paulj; Thompson, Brucen; Wiener, Jeffreye

Collapse Box


Objective: To evaluate whether maternal human immunodeficiency virus type 1 (HIV-1) RNA levels in the serum/plasma of mothers at or close to the time of delivery affects the rate of disease progression among vertically HIV-1-infected children and whether it correlates with other parameters affecting infant disease progression.

Methods: International meta-analysis of eight studies with 574 HIV-1 infected infants with available maternal HIV-1 RNA measurements at or close to delivery and clinical follow-up. The primary outcome was disease progression (stage C disease or death, n = 178). Cohort-stratified Cox models were used.

Results: Higher maternal HIV-1 RNA level at or close to delivery significantly increased disease progression risk [hazard ratio (HR), 1.25; 95% confidence interval (CI), 1.04–1.52 per 1 log10 increase; P = 0.02) with a borderline effect on mortality (HR, 1.26; 95% CI, 0.96–1.65; P = 0.10]. The association with disease progression risk was strong in the first 6 months of life (HR, 1.77; 95% CI, 1.28–2.45; P = 0.001), but not subsequently (HR, 1.03; 95% CI, 0.81–1.30). Maternal HIV-1 RNA, early infant HIV-1 RNA (at 30–200 days after birth) and infant CD4 were independent predictors of disease progression in the first 6 months. Maternal HIV-1 RNA at or close to delivery correlated with early infant HIV-1 RNA (r = 0.26, P < 0.001). Effects were independent of maternal and infant treatment.

Conclusions: Higher maternal HIV-1 RNA at or close to delivery strongly predicts disease progression for HIV-1-infected infants, especially in their first 6 months of life and correlates with the early peak of viremia in the infected child.

© 2004 Lippincott Williams & Wilkins, Inc.


Article Tools


Article Level Metrics

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.