Search

Background. South Africa implemented lifelong antiretroviral therapy (ART) for prevention of mother-to-child transmission (PMTCT) of HIV to reduce the risk of vertical HIV transmission. The rate of in utero transmission of HIV in very low-birthweight (VLBW)(< 1 500 g) infants, which is a high-risk population, is largely unknown. Objectives. To determine the rate of in utero transmission in VLBW infants and to describe the characteristics of the infants infected with HIV. Methods. This was a retrospective cross-sectional study of VLBW infants exposed to HIV, over a two-year period, at two hospitals in the Eastern Cape. Relevant data (maternal and infant) were extracted from medical records and analysed. Descriptive statistics are reported for all variables as means, medians and standard deviations for continuous numerical variables, and as percentages for categorical data. A p-value <0.05 was considered significant. Results. The hospital registers identified 273 VLBW infants; nine were excluded. Four infants (1.5%) were HIV polymerase chain reaction (PCR)-positive. The viral load was significantly higher among mothers of infants who tested HIV PCR-positive (Mann-Whitney U test; p=0.001). HIV-positive infants had a higher median weight (1 333 g v. 1 190 g) at birth; and mothers of HIV-positive infants were slightly older (31 v. 28 years). Both of these characteristics were not statistically significant. Conclusion. The study demonstrates a low prevalence of HIV in a high-risk group of VLBW infants. This rate is comparable to the national prevalence for all infants. Clinicians should aim for HIV viral suppression throughout pregnancy to achieve the global target of elimination of mother-to-child transmission. [ABSTRACT FROM AUTHOR]

Background: Congenital rubella syndrome (CRS) includes disorders associated with intrauterine rubella infection. Incidence of CRS is higher in countries with no rubella-containing vaccines (RCV) in their immunization schedules. In the World Health Organization African region, RCVs are being introduced as part of the 2012-2020 global measles and rubella strategic plan. This study aimed to describe the epidemiology of confirmed CRS in South Africa prior to introduction of RCVs in the immunization schedule., Methods: This was a descriptive study with 28 sentinel sites reporting laboratory-confirmed CRS cases in all 9 provinces of South Africa. In the retrospective phase (2010 to 2014), CRS cases were retrieved from medical records, and in the prospective phase (2015 to 2017) clinicians at study sites reported CRS cases monthly., Results: There were 42 confirmed CRS cases in the retrospective phase and 53 confirmed CRS cases in the prospective phase. Most frequently reported birth defects were congenital heart disease and cataracts. The median age of mothers of CRS cases was 21 years in the retrospective phase (range: 11 to 38 years) and 22 years in the prospective phase (range: 15 to 38 years)., Conclusion: Baseline data on laboratory-confirmed CRS will enable planning and monitoring of RCV implementation in the South African Expanded Programme on Immunization program. Ninety-eight percent of mothers of infants with CRS were young women 14-30 years old, indicating a potential immunity gap in this age group for consideration during introduction of RCV., (© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America.)

Objective: We have assessed HIV-1 disease progression among HIV-1-positive mothers in relation to duration of any or exclusive breast feeding in the context of ANRS 12174 trial., Methods: The analysis was completed on 203, 212, 272 and 529 HIV-1-positive and lactating mothers with CD4 count >350 cells/µL from Burkina Faso, South Africa, Uganda and Zambia, respectively. The trial compared lamivudine and lopinavir/ritonavir as a peri-exposure prophylaxis during a 50-week follow-up time. A multiple logistic regression model was run with the mothers' weight, CD4 count and HIV-1 viral load as separate dependent variables, then combined into a dependent composite endpoint called HIV-1 disease progression where HIV-1 viral load was replaced by the HIV-1 clinical stage. Exclusive or predominant breast feeding (EPBF) and any breastfeeding duration were the key explanatory variables., Results: In the adjusted model, the associations between EPBF duration and weight change, CD4 cell count and the HIV-1 viral load were consistently insignificant. The CD4 cell count was associated with a significantly higher mothers' body mass index (BMI; a mean increase of 4.9 (95% CI 2.1 to 7.7) CD4 cells/µL per each additional kilogram per square metre of BMI) and haemoglobin concentration (19.4 (95% CI 11.4 to 27.4) CD4 cells/µL per each additional gram per decilitre of haemoglobin concentration). There was no significant association between EPBF duration and HIV-1 disease progression. A higher education level was a factor associated with a slower HIV-1 disease progression., Conclusion: Breast feeding was not a risk factor for a faster progression of HIV-1 disease in mothers of this cohort with a baseline CD4 cell count >350 cells/µL., Trial Registration Number: NCT0064026; Post-results., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)