Pediatric HIV-1 in Kenya: Pattern and Correlates of Viral Load and Association With Mortality ,

Citation:
Elizabeth Maleche Obimbo MBCB, et al. "Pediatric HIV-1 in Kenya: Pattern and Correlates of Viral Load and Association With Mortality ,." J Acquir Immune Defic Syndr. 2009.

Abstract:

Abstract
Background—There is limited information regarding the pattern and correlates of viral replication
in vertically HIV-1–infected children and its role on their outcomes in resource-limited settings.
Methods—HIV-1–infected infants were followed from birth to 24 months. Serial HIV-1 RNA
levels were compared in infants infected in utero (<48 hours), peripartum (48 hours–1 month), and
late postnatal (after 1 month). Cofactors for viral peak [highest viral load (VL) within 6 months of
infection] and set point and mortality were determined.
Results—Among 85 HIV-1–infected infants, 24 were infected in utero, 41 peripartum, 13 late
postnatal; 7 had no 48-hour assay. HIV-1 VL set point was significantly lower in infants infected >1
month vs. ≤1 month (5.59 vs. 6.24 log10 copies per milliliter, P = 0.01). Maternal VL correlated with
peak infant VL (P < 0.001). Univariately, infant peak and set point VL and 6-month CD4% <15%
predicted mortality; and 6-month CD4% <15% remained independently predictive in multivariate
analyses (hazard ratio = 4.85, 95% confidence interval: 1.90 to 12.36).
Conclusions—Infants infected after the age of 1 month contained virus better than infants infected
before 1 month of age. Maternal VL predicted infant VL, which, in turn was associated with early
mortality.

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