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Virus levels in untreated African infants infected with human immunodeficiency virus type 1
1Viral Epidemiology Branch, National Cancer Institute, National Institute of Allergy and Infectious Diseases, Rockville, MD 20862, USA. biggarb@epndce.nci.nih.gov
Insights
Human immunodeficiency virus (HIV) levels in Malawian infants were high at diagnosis, regardless of infection route. Initial high viral loads predicted later levels, but infection timing and route did not significantly impact HIV levels one year post-infection.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Public Health in Developing Nations
Background:
- Infants with human immunodeficiency virus (HIV) in developed regions experience rapid disease progression and high viral loads.
- Understanding HIV dynamics in untreated infants in resource-limited settings is crucial for public health interventions.
Purpose of the Study:
- To assess human immunodeficiency virus (HIV) levels in untreated infants in Malawi.
- To determine the influence of infection route and timing on HIV viral load in infants.
Main Methods:
- Analysis of dried blood spots from infants in Malawi (1994-1997).
- Nucleic acid silica-bound amplification technique used for HIV quantification.
- Comparison of viral loads based on infection route (in utero, perinatal, breast-feeding) and timing.
Main Results:
- 83% of umbilical cord blood (CB)-positive samples had HIV levels >10,000 copies/mL, with a median of 78,000 copies/mL.
- Median initial HIV levels were 355,000 copies/mL for perinatally infected and 130,000 copies/mL for breast-feeding infected infants.
- Initial viral load predicted levels at 1 year post-infection (P=.005); however, no significant difference in HIV levels was observed at 1 year across different infection routes.
Conclusions:
- HIV viral loads are high in Malawian infants at diagnosis, irrespective of the route of infection.
- While initial viral load is predictive, the route and timing of HIV infection do not significantly alter viral levels one year after infection.
- The majority of CB-positive infants were infected before labor, indicated by viral loads exceeding maternal levels.
Abstract:
In developed areas, human immunodeficiency virus (HIV)-infected infants have high virus levels and rapidly progress to death. HIV levels were assessed in 1994-1997 in untreated infants in Malawi by analysis of dried blood spots tested by nucleic acid silica-bound amplification. Of 24 umbilical cord blood (CB)-positive samples, 83% had >10,000 copies/mL. The median virus level was 78,000 copies/mL. First positive sample median levels were 355,000 copies/mL among 52 perinatally infected infants and 130,000 copies/mL among 43 infants infected by breast-feeding. Virus levels were stable, and initial levels predicted levels 1 year after infection (P=.005), at which time levels did not significantly differ among in utero, perinatally, or postnatally infected infants. Thus, neither age at infection nor route of infection significantly influenced HIV levels measured 1 year after infection. Most (87%) CB-positive infants were infected before labor onset, since virus levels greatly exceeded those expected in their mothers.