Population Attributable Fractions for Late Postnatal Mother-To-Child Transmission of HIV-1 in Sub-Saharan Africa

J Acquir Immune Defic Syndr. 2010 Jul;54(3):311-6. doi: 10.1097/QAI.0b013e3181d61c2e.


Objectives: Assess population attributable fractions (PAFs) for late postnatal transmission (LPT) of HIV-1 in a cohort of HIV-1-exposed infants.

Methods: We used data established from a risk factor analysis of LPT (negative HIV-1 results through the 4-6 week visit, but positive assays thereafter through the 12-month visit) from a perinatal clinical trial conducted in 3 sub-Saharan countries. PAFs were calculated as the proportions of excess LPTs attributed to identified risk factors.

Results: For the cohort of 1317 infants, 206 (15.6%) had only low maternal CD4 counts (<200 cells/mm), 332 (25.2%) had only high maternal plasma viral loads (VLs) (>50,000 copies/mL), and 81 (6.2%) had both low CD4 counts and high VLs. Their PAFs were 26.0% [95% confidence interval (CI): 12.0% to 36.0%], 37.0% (95% CI: 22.0% to 51.0%), and 16.0% (95% CI: 6.0% to 25.0%), respectively.

Conclusions: Our PAF analysis illustrates the public health impact of the substantial proportion of LPTs accounted for by high-risk women with both low CD4 counts and high VLs. In light of these results, access to and use of antiretroviral therapy by high-risk HIV-1-infected pregnant women is essential. Additional strategies to reduce LPT for those not meeting criteria for antiretroviral therapy should be implemented.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Africa South of the Sahara / epidemiology
  • CD4 Lymphocyte Count
  • Cohort Studies
  • Female
  • HIV Infections / epidemiology
  • HIV Infections / transmission*
  • HIV Infections / virology
  • HIV-1*
  • Humans
  • Infant
  • Infectious Disease Transmission, Vertical*
  • Pregnancy
  • Risk Factors