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1 July 2007

Volume 196, Number 1
The Journal of Infectious Diseases 2007;196:10–14
© 2007 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2007/19601-0004$15.00
DOI: 10.1086/518511
BRIEF REPORT

Late Postnatal Transmission of HIV‐1 and Associated Factors

Taha E. Taha,1

Donald R. Hoover,4

Newton I. Kumwenda,1

Susan A. Fiscus,5

George Kafulafula,6

Chiwawa Nkhoma,7

Shu Chen,1

Estelle Piwowar,2

Robin L. Broadhead,6

J. Brooks Jackson,2 and

Paolo G. Miotti3

1Department of Epidemiology, Bloomberg School of Public Health, and 2Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, and 3Office of AIDS Research, National Institutes of Health, Bethesda, Maryland; 4Department of Statistics and Institute for Health, Health Care Policy and Aging Research, Rutgers University, Piscataway, New Jersey; 5Department of Microbiology and Immunology, University of North Carolina, Chapel Hill; 6Departments of Obstetrics and Gynecology and of Pediatrics, College of Medicine, University of Malawi, and 7Johns Hopkins University–College of Medicine–Ministry of Health Research Project, Blantyre, Malawi

Background.The present study was undertaken to determine the risk and timing of late postnatal transmission (LPT) of human immunodeficiency virus type 1 (HIV‐1).

Methods.Breast‐fed infants previously enrolled in 2 trials of antiretroviral prophylaxis were monitored in Malawi. Kaplan‐Meier and proportional hazard models assessed cumulative incidence and association of factors with LPT.

Results.Overall, 98 infants were HIV infected, and 1158 were uninfected. The cumulative risk of LPT at age 24 months was 9.68% (95% confidence interval, 7.80%–11.56%). The interval hazards at 1.5–6, 6–12, 12–18, and 18–24 months were 1.22%, 4.05%, 3.48%, and 1.27%, respectively.

Conclusions.The risk of LPT beyond 6 months is substantial. Weaning at 6 months could prevent >85% of LPT.

Received 9 October 2006; accepted 23 January 2007; electronically published 24 May 2007.

Reprints or correspondence: Dr. Taha E. Taha, Rm. E7138, Dept. of Epidemiology, Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205 ().

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  • Potential conflicts of interest: none reported.

    Presented in part: XVI International AIDS Conference, 15 August 2006, Toronto, Canada (abstract TUPE0337).

    Financial support: Fogarty International Center, National Institutes of Health (AIDS FIRCA award 5R03TW01199 and supplement); Doris Duke Charitable Foundation; Gustav Martin Innovative Research Fund of the Johns Hopkins Bloomberg School of Public Health; discretionary fund of the HIV Prevention Trials Network, Division of AIDS, National Institutes of Health (grant U01 A148005).

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