Cell-free (RNA) and cell-associated (DNA) HIV-1 and postnatal transmission through breastfeeding.
INTRODUCTION:Transmission through breastfeeding remains important for mother-to-child transmission (MTCT) in resource-limited settings. We quantify the relationship between cell-free (RNA) and cell-associated (DNA) shedding of HIV-1 virus in breastmilk and the risk of postnatal HIV-1 transmission in...
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doaj-59ef07ab23674e36ab15ba06f8f007902020-11-24T23:50:55ZengPublic Library of Science (PLoS)PLoS ONE1932-62032012-01-01712e5149310.1371/journal.pone.0051493Cell-free (RNA) and cell-associated (DNA) HIV-1 and postnatal transmission through breastfeeding.James NdiranguJohannes ViljoenRuth M BlandSiva DanaviahClaire ThornePhilippe Van de PerreMarie-Louise NewellINTRODUCTION:Transmission through breastfeeding remains important for mother-to-child transmission (MTCT) in resource-limited settings. We quantify the relationship between cell-free (RNA) and cell-associated (DNA) shedding of HIV-1 virus in breastmilk and the risk of postnatal HIV-1 transmission in the first 6 months postpartum. MATERIALS AND METHODS:Thirty-six HIV-positive mothers who transmitted HIV-1 by breastfeeding were matched to 36 non-transmitting HIV-1 infected mothers in a case-control study nested in a cohort of HIV-infected women. RNA and DNA were quantified in the same breastmilk sample taken at 6 weeks and 6 months. Cox regression analysis assessed the association between cell-free and cell-associated virus levels and risk of postnatal HIV-1 transmission. RESULTS:There were higher median levels of cell-free than cell-associated HIV-1 virus (per ml) in breastmilk at 6 weeks and 6 months. Multivariably, adjusting for antenatal CD4 count and maternal plasma viral load, at 6 weeks, each 10-fold increase in cell-free or cell-associated levels (per ml) was significantly associated with HIV-1 transmission but stronger for cell-associated than cell-free levels [2.47 (95% CI 1.33-4.59) vs. aHR 1.52 (95% CI, 1.17-1.96), respectively]. At 6 months, cell-free and cell-associated levels (per ml) in breastmilk remained significantly associated with HIV-1 transmission but was stronger for cell-free than cell-associated levels [aHR 2.53 (95% CI 1.64-3.92) vs. 1.73 (95% CI 0.94-3.19), respectively]. CONCLUSIONS:The findings suggest that cell-associated virus level (per ml) is more important for early postpartum HIV-1 transmission (at 6 weeks) than cell-free virus. As cell-associated virus levels have been consistently detected in breastmilk despite antiretroviral therapy, this highlights a potential challenge for resource-limited settings to achieve the UNAIDS goal for 2015 of eliminating vertical transmission. More studies would further knowledge on mechanisms of HIV-1 transmission and help develop more effective drugs during lactation.http://europepmc.org/articles/PMC3532207?pdf=render |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
James Ndirangu Johannes Viljoen Ruth M Bland Siva Danaviah Claire Thorne Philippe Van de Perre Marie-Louise Newell |
spellingShingle |
James Ndirangu Johannes Viljoen Ruth M Bland Siva Danaviah Claire Thorne Philippe Van de Perre Marie-Louise Newell Cell-free (RNA) and cell-associated (DNA) HIV-1 and postnatal transmission through breastfeeding. PLoS ONE |
author_facet |
James Ndirangu Johannes Viljoen Ruth M Bland Siva Danaviah Claire Thorne Philippe Van de Perre Marie-Louise Newell |
author_sort |
James Ndirangu |
title |
Cell-free (RNA) and cell-associated (DNA) HIV-1 and postnatal transmission through breastfeeding. |
title_short |
Cell-free (RNA) and cell-associated (DNA) HIV-1 and postnatal transmission through breastfeeding. |
title_full |
Cell-free (RNA) and cell-associated (DNA) HIV-1 and postnatal transmission through breastfeeding. |
title_fullStr |
Cell-free (RNA) and cell-associated (DNA) HIV-1 and postnatal transmission through breastfeeding. |
title_full_unstemmed |
Cell-free (RNA) and cell-associated (DNA) HIV-1 and postnatal transmission through breastfeeding. |
title_sort |
cell-free (rna) and cell-associated (dna) hiv-1 and postnatal transmission through breastfeeding. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2012-01-01 |
description |
INTRODUCTION:Transmission through breastfeeding remains important for mother-to-child transmission (MTCT) in resource-limited settings. We quantify the relationship between cell-free (RNA) and cell-associated (DNA) shedding of HIV-1 virus in breastmilk and the risk of postnatal HIV-1 transmission in the first 6 months postpartum. MATERIALS AND METHODS:Thirty-six HIV-positive mothers who transmitted HIV-1 by breastfeeding were matched to 36 non-transmitting HIV-1 infected mothers in a case-control study nested in a cohort of HIV-infected women. RNA and DNA were quantified in the same breastmilk sample taken at 6 weeks and 6 months. Cox regression analysis assessed the association between cell-free and cell-associated virus levels and risk of postnatal HIV-1 transmission. RESULTS:There were higher median levels of cell-free than cell-associated HIV-1 virus (per ml) in breastmilk at 6 weeks and 6 months. Multivariably, adjusting for antenatal CD4 count and maternal plasma viral load, at 6 weeks, each 10-fold increase in cell-free or cell-associated levels (per ml) was significantly associated with HIV-1 transmission but stronger for cell-associated than cell-free levels [2.47 (95% CI 1.33-4.59) vs. aHR 1.52 (95% CI, 1.17-1.96), respectively]. At 6 months, cell-free and cell-associated levels (per ml) in breastmilk remained significantly associated with HIV-1 transmission but was stronger for cell-free than cell-associated levels [aHR 2.53 (95% CI 1.64-3.92) vs. 1.73 (95% CI 0.94-3.19), respectively]. CONCLUSIONS:The findings suggest that cell-associated virus level (per ml) is more important for early postpartum HIV-1 transmission (at 6 weeks) than cell-free virus. As cell-associated virus levels have been consistently detected in breastmilk despite antiretroviral therapy, this highlights a potential challenge for resource-limited settings to achieve the UNAIDS goal for 2015 of eliminating vertical transmission. More studies would further knowledge on mechanisms of HIV-1 transmission and help develop more effective drugs during lactation. |
url |
http://europepmc.org/articles/PMC3532207?pdf=render |
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