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Primary HIV-1 infection in African children infected through breastfeeding
François Rouet1, Narcisse Elenga, Philippe Msellati
1CeDReS, CHU de Treichville, Abidjan, Côte d'Ivoire.
Insights
Acute retroviral syndrome and primary viremia are common in African children with HIV-1 acquired through breastfeeding. Early recognition of symptoms like rash and lymphadenopathy can aid in timely diagnosis and care.
Area of Science:
- Pediatric Infectious Diseases
- Viral Load Monitoring
- Public Health in Africa
Background:
- Breastfeeding is a significant route of postnatal HIV-1 transmission in African children.
- Early recognition of acute retroviral syndrome (ARS) is crucial for timely intervention.
- Understanding primary viremia in infants is essential for managing HIV-1 infection.
Purpose of the Study:
- To describe acute retroviral syndrome (ARS) in African children infected with HIV-1 via breastfeeding.
- To characterize primary viremia associated with early HIV-1 infection in infants.
- To identify clinical signs indicative of primary HIV-1 infection in a high-transmission setting.
Main Methods:
- A matched case-control study was conducted retrospectively within the ANRS 049 DITRAME project in Abidjan, Côte d'Ivoire (1995-1998).
- Cases were infants with confirmed postnatal HIV-1 infection through breastfeeding, identified by DNA PCR.
- Controls were uninfected breastfed infants matched for age and exposure; clinical signs and plasma HIV-1 RNA viral load were assessed.
Main Results:
- 95.5% of HIV-1 infected infants (n=22) presented with at least one clinical sign of ARS, compared to 61.4% of controls (n=44).
- Independent factors associated with primary HIV-1 infection included mononucleosis-like syndrome (OR 8.3), dermatitis (OR 6.0), and generalized lymphadenopathy (OR 26.5).
- Median initial plasma HIV-1 RNA viral load was 5.92 log10 copies/ml, decreasing to 4.96 log10 copies/ml at 12 months.
Conclusions:
- Clinical signs such as rash, lymphadenopathy, and mononucleosis-like syndrome are valuable indicators of primary HIV-1 infection in breastfed African infants.
- These findings can aid in recognizing early pediatric HIV-1 cases and targeting infants for HIV RNA/DNA testing.
- Early diagnosis facilitates prompt initiation of care for infants with primary HIV-1 infection.
Objectives:
To describe acute retroviral syndrome and associated primary viraemia in African children infected with HIV-1 through breastfeeding.
Design:
Matched case-control study performed retrospectively within the ANRS 049 DITRAME project conducted in 1995-1998 in Abidjan, Côte d'Ivoire.
Methods:
Cases were children infected by HIV-1 postnatally through breastfeeding. All were HIV-1 negative by DNA PCR at least 45 days of age, but positive on a subsequent sample. This period was considered as surrounding the estimated date of postnatal contamination. Signs/symptoms occurring within this period were recorded in cases and compared with those occurring during the same time period in uninfected breastfed children (controls). For cases, plasma specimens were tested for HIV-1 plasma RNA using the branched DNA assay.
Results:
Of 22 infants infected postnatally (median age at first positive sample, 185 days; range, 87-373 days), 21 (95.5%) exhibited at least one clinical sign, compared with only 27 of the 44 (61.4%) uninfected children (P = 0.003). Three independent factors were associated with primary HIV-1 infection: mononucleosis-like syndrome [odds ratio (OR), 8.3; 95% confidence interval (CI), 1.4-47.8], dermatitis (OR, 6.0; CI, 1.1-31.9), and generalized lymphadenopathy (OR, 26.5; CI, 2.0-348.4). Among cases, initial median plasma HIV-1 RNA viral load was 5.92 log10 copies/ml; this declined to 4.96 log10 12 months after the first positive viral load.
Conclusions:
These results may be useful for the recognition of early paediatric cases of postnatal transmission in Africa and could enable targeting of those who should benefit from HIV RNA or DNA testing for primary HIV-1 infection and their subsequent care.