Transcript Slide 1

VERTICAL TRANSMISSION OF HIV INFECTION IN TWINS
Tatjana Kolupajeva, Ludmila Guseva, Valentina Sitkare, Diana Dusacka,
Inga Januskevica, Natalija Repuscenko, Jelena Storozenko, Baiba Rozentale
Riga East University Hospital Latvian Center of infectious Diseases
Introduction
According to WHO data risk of vertical transmission of HIV infection from mother to child without any
intervention is 20-40 %, but in the era of ART this risk can be reduced to 2-8 %. Latvia the first case of HIV
transmission was registered in 1998. On January the 1st, 2014, number of HIV infected children aged 1m. - 16y.o.
was 59. Advanced HIV disease in mother associated with likelihood of transmission to infant. Data that twins born first
are at higher risk of HIV infection suggest many infants remain uninfected until time of delivery. As additional factors of
risk transmission are considered mode of delivery, mother’s age, smoking, intravenous drug using (IVD).
Aim
To analyze the cases of twins born to HIV-1 infected mothers enrolled in care in Latvian Center of Infectious
disease (2007 -2013).
Material and Methods
We investigated 9 twin pairs, who were born in 2007-2013 (in 2007- 1, 2010-1, 2012-2, 2013-5). Through
Caesarean section delivered 7 twins, vaginally – 2, sex identical were 6 pairs (boys- 2, girls – 4). For diagnoses of
HIV infection in infants ELISA kits for the detection and confirmation of HIVp24 core Ag (Innotest) and rt-RT PCR kit
(Cobas AmpliPrep/TaqMan HIV-1 system, Roche) for HIV RNA detection (detection limit 20 cop/ml) and
quantification were used. CD4 + cell count were detected by flow cytometry. Third generation MEIA assay (ABBOTT)
was used for the demonstration of anti-HIV seroreversion in uninfected infants.
Results
The first twin pair was presented to hospital in
2007, then 1 and 2 in 2010 and 2012 accordingly.
Significant increasing of twins (5) born to HIV-1 infected
mothers was observed in 2013. Prematurity (31-37
weeks) of deliveries observed in 89 % (8/9) and
maternal age >30 (56 % - 5/9) were regarded as a
risk factors. Mother’s viral load was from undetectable
(2/9 – 22%) to 105 cop/ml (1/9 – 11% ), more often (
6/9 - 67% ) from 102 ( min- 5.9 102) to 10 4 ( max7.7 104) , CD4+ - from 174 to 816 cells /mm3., only in
1 (11 % ) > 700, as an additional risk factor in 3(
3/9 – 33% ) < 500 cells/mm3 (174- 396). Five HIV-1
infected mothers received antiretroviral therapy (2 –
from 14 weeks of pregnancy, others – from 23, 25 and
30 week), four didn’t. At time of first visit (as a rule at
age 5 - 9 weeks, 1 twin – at 10 month ) all 18 infants
have negative HIV-1 Ag and 16/18 (89 %) undetectable level of HIV viral load. Two first born
children from different twins have detectable HIV-1 viral
load - 7.2 x102(Caesarean section) and 1.2x105 cop/ml
(vaginally delivery), one was born to mother who didn’t
receive antiretroviral therapy, the other – to mother who
began ART at week 25 of gestation. The rest infants
hadn’t detectable HIV RNA and HIV antibody in age 1424 m. or till now are on follow up with no detectable
HIV RNA and seroreversion trend in levels of HIV
antibodies.
Conclusion
Number of twin deliveries from HIV-1 infected
mothers increased in Latvia, like in other industrial
countries. Recently vertical HIV transmission is proved
in 2/18 infants from twin pairs, both first born. One
mother didn’t receive antiretroviral therapy, the second
did from the week 25. Most twin’s mothers have one or
more vertical transmission risk factors (age, born
prematurity, viral load, CD4+ count).
Mother
Cases
Birth
year
Age
Delivery
Viral load
cop/ml
Children
CD4+
cells/mm3
ART
IVD
Weight
g.
1st
37 w.
1
2007 23
C.
section
6.3E5
-
-
no data
2nd
1st
33/34 w.
2
2010 31
C.
section
5.9E2
610
-
2nd
1st
2012 32
C.
section
37 w.
4
2012 32
C.
section
5.6E3
816
-
1st
688
14w.
1st
5
2013 34
3.9E4
396
25w.
2nd
6
2013 28
C.
section
1st
under
detection
limit
267
14w.
2013 39
C.
section
2nd
1st
7.7E4
174
30w.
2013 26
2nd
1st
C.
section
7.3E2
519
23w.
2013 25
2nd
1st
C.
section
1.8E3
687
-
2460
not
neg.
detected
2560
not
neg.
detected
1700
1.2E5
1632
not
detected neg.
2200
not
neg.
detected
2250
not
neg.
detected
1840
not
neg.
detected
2220
not
neg.
detected
2700
not
neg.
detected
2590
not
neg.
detected
3400
not
detected neg.
2440
not
detected neg.
neg.
no data
37 w.
9
1720
not
neg.
detected
yes
38 w.
8
1660
not
neg.
detected
yes
34 w.
7
1850
not
neg.
detected
yes
Spont.
37 w.
1820
not
neg.
detected
no
2nd
31 w.
neg.
yes
2nd
under
detection
limit
7.1E2
not
no data detected neg.
yes
32/33 w.
3
2410
Viral load
HIV Ag
cop/ml
yes
2nd
Literatura
1. Scavalli CP, Mandelbrot L, Berrebi A, Batallan A, Cravello L, Pannier E, Hamrene K, Ciraru-Vigneron N, Faye A, Warszawski J;
ANRS EPF. Twin pregnancy as a risk factor for mother-to-child transmission of HIV-1: trends over 20 years. AIDS. 2007 May
11;21(8):993-1002.
2. Michael Carter Twin pregnancies involve greater risk of mother-to-child HIV transmission unless potent anti-HIV drugs used.
http://www.aidsmap.com/Twin-pregnancies-involve-greater-risk-of-mother-to-child-HIV-transmission-unless-potent-anti-HIV-drugsused/page/1427215/