University of Zambia Medical Library
Perinatal and Postnatal Transmission of HIV (AIDS in Zambia Bibliography #33-35)
- (#33) "Perinatal Transmission of HIV-1 in Zambia."
Hira, S.K., Kamanga, J., Bhat, G.J., Mwale, C., Tembo, G., et al. (1989)
British Medical Journal; Vol 299(6710); 1989; pp 1250-1252
Geographical area: Lusaka; Keywords: Perinatal transmission; Location: UNZA Medical Library
In order to determine the occurrence of vertical transmission of HIV-1 from women
positive for the virus and the prognosis for their babies, 1954 women presenting in labour
at the University Teaching Hospital in Lusaka, Zambia were tested for HIV-1. The
newborn babies were also tested and women positive for the virus were followed up with
their babies for two years. Women and babies were tested over two years for signs of
seroconversion and symptoms of infection with HIV, AIDS-related complex, and AIDS.
Of the 109 babies born to seropositive mothers and available for follow up, 18 died
before 8 months, 14 with clinical AIDS. Of the 91 remaining, 23 were seropositive, and
a further five infected babies had died, four were terminally ill, 17 had AIDS-related
complex, and two had no symptoms. The overall rate of perinatal transmission was 42
out of 109 (39 per cent).The overall mortality of infected children at 2 years was 19 out
of 42 (44 per cent). All babies had received live attenuated vaccines before 8 months with
no adverse effects. In conclusion, vertical transmission from infected mothers to their
babies is high in Zambia and prognosis is poor for the babies. -
- (#34) Apparent vertical transmission of human immunodeficiency virus type 1 by breastfeeding in Zambia
Hira, S.K., Mangrola, G., Mwale, C., Chintu, C., et al., (1990) Journal of Paediatrics, Vol 117, No.3, pp. 421-424.
Geographical area: Lusaka; Key words: Perinatal transmission, breastfeeding, dry sex; Location: UNZA Medical Library
Objectives:
To determine the risk factors for maternal HIV infection in Zambia and
the probability of transmission of HIV by breastfeeding.
Methods:
Between February and May 1987, a total of 1954 women admitted to labour
wards at the University Teaching Hospital, Lusaka, Zambia, were studied. After
informed consent was obtained a detailed history was taken, a thorough physical
examination was performed, and 3 to 5 ml of venous blood was collected for HIV
serodiagnostic tests. Cord blood was obtained from all live and stillborn infants. The
serum specimens of the mother, the baby, and in some cases the father were tested for anti-HIV-1 antibodies by ELISA with use of recombinant HIV-1gp41 and gp120
peptides. All babies were examined at regular intervals at the hospital's paediatric
clinics. Although an attempt was made to examine all seronegative women at yearly
intervals, only 634 (36.7%) of them returned for examination and additional serologic
testing at the end of 1 year. Among them were 30 HIV-1 seronegative women whose
husbands were seropositive for HIV-1 at the time of delivery.
Results:
- The mean age of HIV-1 seronegative women who entered the study in
abour was 25 years. The follow-up cohort of 634 women was representative of the
original sample in terms of age (24.5 years), economic status, and marital status: 537
(84.9 per cent) were married, 72 (11.4 per cent) had never been married, and 24 (3.8
per cent) were divorced or widowed; 173 (27.0 per cent) were primigravidas.
- At the time of delivery, 327 (11.6 per cent) of 1956 women were confirmed to be seropositive for HIV antibodies, and seven others (0.14 per cent) had circulating HIV p24 antigen; 1720 seronegative women were entered into the study, but only 634 returned one year after delivery for repeat serologic testing. Two of the seven children born to mothers who were seropositive only for HIV p24 antigen at delivery died of bronchopneumonia
and recurrent diarrhoea before one year of age without having undergone HIV testing;
the remaining five were alive, healthy and seronegative for HIV when examined at 2
years of age.
- Three incident HIV cases occurred in the 19 children born to mothers
who had seroconversion to HIV during follow-up. One of the infected children had
symptoms of HIV infection two years after seroconversion.
- Of the 634 HIV
seronegative women screened at 1 year of follow-up, 19 had become seropositive for
HIV, an annual incidence of 3 per cent: the maternal risk of acquiring HIV being
almost four times higher in those whose husbands were seropositive at time of delivery.
The relative risk of acquiring HIV-1 infection was 12 times greater among women with
a history of genital ulceration during the follow-up period and was 28 times greater
among women practicing "dry sex," in which a cloth is used to remove vaginal
secretions during intercourse.
- In all the incident cases of HIV in women, the
infection was asymptomatic, although in five (26.3 per cent) of the 19 generalised,
persistent adenopathy developed within a year after the infection was acquired. In three (15.8 per cent) of these incident cases the women had had spontaneous abortions during the year in which seroconversion occurred.
Conclusions:
- The results suggest that breastfeeding may be an important mode of
HIV-1 transmission in children who are breastfed by newly seroconverted mothers.
- Women at high risk of acquiring HIV, particularly those who are married to or have
a sexual relationship with HIV-infected men, should not breastfeed their children.
-
- (#35) Possible role of breastfeeding in transmission of HIV-1 in newly seroconverted mothers in Lusaka, Zambia
Mpabalwani, M., Luo, C., Mwansa, P., Bhat, G., Chintu, C., et al. (1993)
Paper presented at the VIIIth International Conference on AIDS in Africa,
Marrakech, 1993
Geographical area: Lusaka; Key words: Perinatal transmission, breastfeeding;
Location: UNZA Medical Library
Objective:
To examine the role of breastfeeding in the transmission of HIV-1. This study
is part of the ongoing multicentre study on the risk of nosocomial transmission of HIV-1
in paediatric care units in Africa.
Methods:
Hospitalised children at UTH under 5 years old but over 6 months with various
clinical conditions were recruited to the study with informed consent. HIV-1 serology
was done on both the mothers and the children at recruitment. HIV serology was repeated after 12 weeks of follow up.
Results:
A total of 1408 seronegative mother/child pairs were followed up. HIV results revealed that 5 per cent (24/476) of the mothers seroconverted. 15 of these were
breastfeeding. HIV results show that of the breastfeeding children, 13.3 per cent (2/15)
were HIV-positive.
Conclusion:
These preliminary results suggest that breastfeeding may be an important
mode of HIV-1 transmission in children who are breastfed by newly seroconverted
mothers. However, other factors need to be studied to evaluate postnatal transmission of HIV-1 in Africa.
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