HIV-1/AIDS and maternal and child health in Africa

Dabis, François; Ekpini, Ehounou R.

doi:10.1016/s0140-6736(02)08909-2

Cited by 193 publications

(148 citation statements)

References 64 publications

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“…In Cô te d'Ivoire as well as in Africa as a whole, these signs/symptoms also occur in HIV-negative children, albeit less frequently. 23 The similarity of the spectrum of the causes of death in HIV-infected children versus those who are not infected was a limit of our study.…”

Section: Discussionmentioning

confidence: 94%

“…22 The burden of pediatric infection in Africa is likely to increase in the future despite encouraging initiatives focusing on the use of abbreviated ARV regimens for the prevention of mother-to-child transmission (PMTCT). 23 The HIV-1 dynamics and its prognostic value in African children have not been investigated except in Malawi. 24,25 The natural history of pediatric HIV-1 disease requires additional documentation according to the route of infection (in utero, peripartum, and postpartum via breastfeeding).…”

mentioning

confidence: 99%

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Pediatric Viral Human Immunodeficiency Virus Type 1 RNA Levels, Timing of Infection, and Disease Progression in African HIV-1-Infected Children

Raffi

Sakarovitch²,

Msellati³

et al. 2003

Pediatrics

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ABSTRACT. Objective. To describe plasma human immunodeficiency virus type 1 (HIV-1) RNA levels in African HIV-1-infected children in relation to the timing of infection and disease progression.Methods. A retrospective cohort study was conducted of 80 children who were born to HIV-1-positive mothers and clinically followed from birth to 18 months of age in the ANRS 049 Ditrame project, Abidjan, Cô te d'Ivoire (West Africa). The diagnosis and timing of pediatric HIV-1 infection were determined prospectively according to HIV-1 DNA polymerase chain reaction results. A total of 364 HIV-1 RNA viral load (VL) measurements were assessed retrospectively. Kaplan-Meier analyses and proportional hazards models were used to evaluate the prognostic value of pediatric VL and covariates for HIV disease progression or death.Results. Mean initial positive VL was significantly lower among children who were infected in utero (4.94 log 10 /mL, n ‫؍‬ 12) than in children who were infected later (5.6 -6.1 log 10 /mL, n ‫؍‬ 68). In the first 6 months after diagnosis, HIV-1 RNA levels peaked (>6 log 10 /mL), regardless of timing of infection. Then, a slow decline (overall slope, ؊0.076 log 10 copies/mL/mo) was observed until 18 months of age. A 1 log 10 higher value of the pediatric peak VL (risk ratio [

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Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

Pediatric Viral Human Immunodeficiency Virus Type 1 RNA Levels, Timing of Infection, and Disease Progression in African HIV-1-Infected Children

Raffi

Sakarovitch²,

Msellati³

et al. 2003

Pediatrics

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“…1 Although programmes for the prevention of mother-to-child transmission of HIV are being scaled up at all levels of care, the need to improve HIV/AIDS care, treatment, and counselling for infected children remains critically important. 2 Challenges to optimal care and treatment in subSaharan Africa include limited resources, staff, and laboratory support. 3 The human professional capacity for delivering HIV/ AIDS care is constrained across much of sub-Saharan Africa, where per capita numbers of physicians and nurses are only 1% to 2% of those of the United States.…”

Section: Introductionmentioning

confidence: 99%

Outcome of Hospital Admissions in HIV-infected Children at the Korle Bu Teaching Hospital, Accra, Ghana

Kwara¹,

Shah²,

Renner³

2011

West African Journal of Medicine

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“…However, perinatal transmission of HIV-1 remains a major problem in developing countries because of limited access to antiretroviral therapy (6)(7)(8). In this latter setting, the simple regimen of maternal single-dose intrapartum nevirapine (NVP) and single-dose NVP (sdNVP) for the newborn reduces the risk of mother-to-child HIV-1 transmission (MTCT) by 41% through age 18 mo (9).…”

mentioning

confidence: 99%

Persistence of nevirapine-resistant HIV-1 in women after single-dose nevirapine therapy for prevention of maternal-to-fetal HIV-1 transmission

Palmer

Boltz

Martinson

et al. 2006

Proc. Natl. Acad. Sci. U.S.A.

137

114

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Single-dose nevirapine (sdNVP) for prevention of mother-to-child transmission of HIV-1 can select nevirapine (NVP)-resistant variants, but the frequency, duration, and clinical significance of this resistance is not well defined. We used a sensitive allele-specific PCR assay to assess the emergence and persistence of NVPresistant variants in plasma samples from 22 women with HIV-1 subtype C infection who participated in a study of sdNVP for prevention of mother-to-child transmission of HIV-1. The women were categorized into three groups on the basis of detection of NVP resistance by standard genotype analysis. Group 1 (n ‫؍‬ 6) had NVP resistance detected at 2 and 6 mo after sdNVP, but not at 12 mo. Group 2 (n ‫؍‬ 9) had NVP resistance detected at 2 mo, but not 6 mo. Group 3 (n ‫؍‬ 7) had no NVP resistance detected at any time point. Allele-specific PCR analysis for the two most common NVP resistance mutations (K103N and Y181C) detected NVP-resistant variants in most (16 of 21) samples that were negative for NVP resistance by standard genotype, at levels ranging from 0.1% to 20% 1 yr after treatment. The frequency of NVP-resistant mutations decreased over time, but persisted above predose levels for more than 1 yr in >23% of the women. These findings highlight the urgent need for studies assessing the impact of sdNVP on the efficacy of subsequent antiretroviral therapy containing NVP or other nonnucleoside reverse transcriptase inhibitors.allele-specific PCR ͉ resistance ͉ low-frequency mutants T he treatment of pregnant women with antiretroviral therapy, in combination with zidovudine chemoprophylaxis administered to newborns, has dramatically reduced vertical transmission of HIV in developed countries (1-5). However, perinatal transmission of HIV-1 remains a major problem in developing countries because of limited access to antiretroviral therapy (6-8). In this latter setting, the simple regimen of maternal single-dose intrapartum nevirapine (NVP) and single-dose NVP (sdNVP) for the newborn reduces the risk of mother-to-child HIV-1 transmission (MTCT) by 41% through age 18 mo (9). Moreover, sdNVP has been demonstrated to be more effective than zidovudine chemoprophylaxis alone, and to be equivalent to NVP plus zidovudine in preventing MTCT (9-12). The efficacy of sdNVP in preventing MTCT is attributed to its potent antiviral activity, rapid absorption, placental transfer, and long half-life (13, 14). As a result, its use has been recommended by the World Health Organization as one of several options to reduce MTCT in resource-limited countries [Joint UNAIDS͞WHO press release (2000) (WHO, Geneva)].NVP is a potent nonnucleoside reverse transcriptase inhibitor (NNRTI) of HIV-1 (15-17). If administered as monotherapy, NVP selects for resistant variants within 1 wk, commonly those variants with the K103N and͞or Y181C mutations in reverse transcriptase, which confer cross-resistance to other approved drugs in the NNRTI class (18)(19)(20). The K103N mutation appears to have little effect on the replicative capacity o...

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HIV-1/AIDS and maternal and child health in Africa

Cited by 193 publications

References 64 publications

Pediatric Viral Human Immunodeficiency Virus Type 1 RNA Levels, Timing of Infection, and Disease Progression in African HIV-1-Infected Children

Pediatric Viral Human Immunodeficiency Virus Type 1 RNA Levels, Timing of Infection, and Disease Progression in African HIV-1-Infected Children

Outcome of Hospital Admissions in HIV-infected Children at the Korle Bu Teaching Hospital, Accra, Ghana

Persistence of nevirapine-resistant HIV-1 in women after single-dose nevirapine therapy for prevention of maternal-to-fetal HIV-1 transmission

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