Dynamics of maternal lymphocyte subsets from 3rd trimester to postpartum and their impact on mother-to-child HIV-1 transmission
Date
2010-03-31T11:31:02Z
Authors
Chitsulo, Chimwemwe
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Abstract
Background
Mother-to-child transmission of HIV infection is the primary cause of paediatric
HIV infections worldwide. High HIV infection rates in women of childbearing age
(15-49 years) and efficiency of PMTCT have resulted in the high rate of HIV
incidence and prevalence in children of sub-Saharan Africa. The stark contrast in
the success of PMTCT interventions between the western countries and less
developed countries indicates the need for further research to develop
alternative, easier, and more effective population-based interventions.
Methodology
This was a retrospective cohort study of the medical records of approximately
300 HIV infected women enrolled in the Nevirapine Resistance study between
May 2002 and February 2003. An assessment of the significance of changes in
immunological parameters (CD4 counts, CD4 percentages, CD4/CD8 ratios) and
HIV RNA from 3rd trimester to 6 weeks postpartum and causal associations
vi
between these changes and increased risk of PMTCT was then conducted using
logistic regression models.
Results
Mothers with CD4 counts above 200cells/μL were approximately exhibited onethird
the likelihood of transmitting HIV-1 to their infants than mothers with CD4
counts below 200 cells/μL [OR 0.35 (0.13, 0.95)]. High maternal HIV RNA levels
demonstrated a stronger association with increased risk of PMTCT with women
with postpartum viral loads greater than 100 000 copies/μL exhibiting ten times
the likelihood [OR 10.15 (2.17-47.55)]. Statistically significant mean increases in
CD4 and CD8 cell counts from 3rd trimester to postpartum were observed. Mean
increases in CD4 and CD8 counts demonstrated no association with PMTCT.
Conclusion
CD4 cell counts and CD8 cell counts underwent statistically significant changes
from 3rd trimester to postpartum. These changes seem not to represent any
clinically significant change in maternal disease progression during this time
period and were found not to be associated with PMTCT.
Description
MSc (Med), Faculty of Health Sciences, University ofthe Witwatersrand, 2007
Keywords
HIV-1, mother to child transmission