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Association of recent HIV infection and in-utero HIV-1 transmission

Taha, Taha E.a; James, Maria M.b; Hoover, Donald R.c; Sun, Jina; Laeyendecker, Oliverd,e; Mullis, Caroline E.e; Kumwenda, Johnstone J.f; Lingappa, Jairam R.g; Auvert, Bertranh,i,j; Morrison, Charles S.k; Mofensen, Lynne M.l; Taylor, Allanm; Fowler, Mary G.b; Kumenda, Newton I.a; Eshleman, Susan H.b

doi: 10.1097/QAD.0b013e3283489d45
Basic Science

Objective: We previously developed a multiassay algorithm (MAA) to identify recent HIV infection that includes the BED-capture enzyme immunoassay, an avidity assay based on the Genetic Systems HIV-1/HIV-2 + O enzyme immunoassay, CD4 cell count, and HIV viral load. We used this MAA to evaluate the association between recent maternal HIV infection and in-utero transmission of HIV.

Methods: Plasma samples were collected at delivery from 2561 HIV-infected women in the postexposure prophylaxis of infants-Malawi trial. The MAA described above was used to identify women with recent HIV infection. Logistic regression models assessed association between recent HIV infection and in-utero HIV transmission (defined as a positive infant HIV DNA test at birth).

Results: Seventy-three women were identified as recently infected using the MAA. Those women were younger and had lower parity than women who were identified as not recently infected using the MAA (P < 0.0001 for age and parity). The frequency of in-utero HIV transmission was 17.8% among women identified as recently infected, compared with 6.7% among women identified as not recently infected (13/73 vs. 166/2488, P = 0.001). In a multivariate model, three factors were independently associated with in-utero HIV transmission: recent infection [adjusted odds ratio (AOR): 2.49, 95% confidence interval (CI): 1.30–4.78, P = 0.006], log10 HIV viral load at delivery (AOR: 2.01, 95% CI: 1.60–2.51, P < 0.0001), and younger age (per 10 year increase, AOR: 0.66, 95% CI: 0.43–0.93, P = 0.02).

Conclusion: Results obtained using a MAA suggest that recent maternal HIV acquisition is strongly associated with in-utero HIV transmission, independent of HIV viral load at delivery.

aDepartment of Epidemiology, Johns Hopkins University Bloomberg School of Public Health

bDepartment of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland

cDepartment of Statistics and Biostatistics and Institute for Health, Healthcare Policy and Aging Research, Rutgers University, Piscataway, New Jersey

dLaboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

eDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

fDepartment of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi

gDepartments of Global Health, Medicine, and Pediatrics, University of Washington, Seattle, Washington, USA

hInstitut National de la Santé et de la Recherche Médicale, INSERM U1018, CESP, Villejuif

iHôpital Ambroise-Paré, Assistance Publique- Hôpitaux de Paris, Boulogne

jUniversity of Versailles, Guyancourt, France

kClinical Sciences, Family Health International, Durham, North Carolina

lPediatric, Adolescent, and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland

mEpidemiology Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.

Correspondence to Susan H. Eshleman, MD, PhD, Professor, Department of Pathology, The Johns Hopkins University School of Medicine, Ross Bldg., Room 646, 720 Rutland Ave., Baltimore, MD 21205, USA. Tel: +1 410 614 4734; fax: +1 410 502 9244; e-mail:

Received 25 February, 2011

Revised 21 April, 2011

Accepted 9 May, 2011

© 2011 Lippincott Williams & Wilkins, Inc.