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Mother-to-Child HIV Transmission With In Utero Dolutegravir vs. Efavirenz in Botswana. J Acquir Immune Defic Syndr 2021; 84:235-241. [PMID: 32195745 DOI: 10.1097/qai.0000000000002338] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A large-scale evaluation of mother-to-child transmission (MTCT) with dolutegravir (DTG)-based antiretroviral treatment (ART) has not been conducted previously. SETTING Botswana was the first African country to change from efavirenz (EFV)/tenofovir (TDF)/emtricitabine (FTC) to DTG/TDF/FTC first-line ART. METHODS From April 2015 to July 2018, the Early Infant Treatment Study offered HIV DNA testing at <96 hours of life. Maternal ART regimen was available for screened infants who could be linked to the separate Tsepamo surveillance study database. We evaluated characteristics of HIV-positive infants, and compared MTCT rates by ART regimen for linked infants. RESULTS Of 10,622 HIV-exposed infants screened, 42 (0.40%) were HIV-positive. In total, 5064 screened infants could be linked to the surveillance database, including 1235 (24.4%) exposed to DTG/TDF/FTC and 2411 (47.6%) exposed to EFV/TDF/FTC. MTCT was rare when either regimen was started before conception: 0/213 [0.00%, 95% confidence interval (CI): 0.00% to 1.72%] on DTG, 1/1497 (0.07%, 95% CI: 0.00% to 0.37%) on EFV. MTCT was similar for women starting each ART regimen in pregnancy: 8/999 (0.80%, 95% CI: 0.35% to 1.57%) for DTG and 8/883 (0.91%, 95% CI: 0.39% to 1.78%) for EFV (risk difference 0.11%, 95% CI: -0.79% to 1.06%). Most MTCT events (4/8 with DTG, 6/9 with EFV) occurred when ART was started <90 days before delivery. Infants exposed to DTG in utero had lower baseline HIV RNA compared with other HIV-infected infants. CONCLUSION In utero MTCT in Botswana remains rare in the DTG era. No significant MTCT differences were observed between DTG/TDF/FTC and EFV/TDF/FTC. Risk was highest for both groups when ART was started in the third trimester.
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Nguyen RN, Ton QC, Tran QH, Nguyen TKL. <p>Mother-to-Child Transmission of HIV and Its Predictors Among HIV-Exposed Infants at an Outpatient Clinic for HIV/AIDS in Vietnam</p>. HIV AIDS (Auckl) 2020; 12:253-261. [PMID: 32765117 PMCID: PMC7371555 DOI: 10.2147/hiv.s259592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/28/2020] [Indexed: 11/26/2022] Open
Abstract
Background Mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) is decreasing worldwide; however, achieving the MTCT elimination target of 2% by 2020 and 0% by 2030 is challenging in resource-limited countries. The purpose of this study is to determine the evolution of the HIV transmission rate in infants from 2007 to 2018 and to identify the risk factors of HIV transmission among HIV-exposed infants in Vietnam. Patients and Methods A prospective cohort study of 608 HIV-exposed infants was conducted at the Pediatric Outpatient Clinic (pOPC) of the Women and Children Hospital of An Giang, Vietnam between September 2007 and December 2019. A follow-up registration book was used to collect data, which were entered into Microsoft Excel and analyzed by SPSS version 22.0. Both bivariate and multivariate analyses were carried out to identify associations. Results A total of 608 HIV-exposed infant were enrolled in the study, of which 472 were included in the final analysis. The median age of infants at enrollment to follow-up was 6.3 weeks (interquartile range [IQR]=6.0–6.9 weeks). A total of 42 infants out of 472 were infected with HIV, giving an overall MTCT rate of 8.9% (95% confidence interval (CI)=6.4–12.0). The transmission rate decreased from 27.9% in 2007 to 0% in 2018. Absence of maternal ARV (antiretrovirals) intervention before or during pregnancy (AOR=40.6, 95% CI=5.5–308) and absence of ARV prophylaxis for HIV-exposed infants (AOR=3.4, 95% CI=1.1–10.3) were significantly and independently associated with MTCT of HIV in this study. Conclusion There is a significant progress on the reduction of MTCT rate in An Giang, Vietnam. Absence of ART interventions for mothers and infants are significant factors associated with HIV transmission. Providing free ARV and increasing the coverage of ARV intervention for pregnant women are keys for reducing the MTCT rate in the future.
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Affiliation(s)
- Rang Ngoc Nguyen
- Department of Pediatrics, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
- Women and Children Hospital of an Giang, An Giang, Vietnam
- Correspondence: Rang Ngoc Nguyen Tel +84 913106404 Email
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Li H, Liu J, Tan D, Huang G, Zheng J, Xiao J, Wang H, Huang Q, Feng N, Zhang G. Maternal HIV infection and risk of adverse pregnancy outcomes in Hunan province, China: A prospective cohort study. Medicine (Baltimore) 2020; 99:e19213. [PMID: 32080112 PMCID: PMC7034691 DOI: 10.1097/md.0000000000019213] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study described the prevalence of adverse pregnancy outcomes (APOs) in Chinese HIV-infected pregnant women, and examined the relationship between maternal HIV infection /HIV-related factors and APOs.This prospective cohort study was carried out among 483 HIV-infected pregnant women and 966 HIV-uninfected pregnant women. The HIV-infected and HIV-uninfected women were enrolled from midwifery hospitals in Hunan province between October 2014 and September 2017. All data were extracted in a standard structured form, including maternal characteristics, HIV infection status, HIV-related factors and their pregnancy outcomes. APOs were assessed by maternal HIV infection status and HIV-related factors using logistic regression analysis.The incidences of stillbirth (3.9% vs 1.1%), preterm birth (PTB) (8.9% vs 3.7%), low birth weight (LBW) (12.2% vs 3.1%) and small for gestational age (SGA) (21.3% vs 7.0%) were higher in HIV-infected women than HIV-uninfected women, with adjusted ORs of 2.77 (95%CI: 1.24-6.17), 2.37 (95%CI: 1.44-3.89), 4.20 (95%CI: 2.59-6.82) and 3.26 (95%CI: 3.26-4.64), respectively. No differences were found in neonatal asphyxia or birth defects between HIV-infected and HIV-uninfected groups, with adjusted ORs of 1.12 (95%CI: 0.37-3.43) and 1.10 (95%CI: 0.51-2.39), respectively. Among HIV-infected pregnant women, different antiretroviral (ARV) regimens were significantly associated with stillbirths, but not PTB, LBW or SGA. Compared with untreated HIV infection (10.1%), both mono/dual therapy and HAART were associated with a reduced risk of stillbirths (2.0% and 3.2%, respectively), with an AOR of 0.19 (95%CI: 0.04-0.92) and 0.31 (95%CI: 0.11-0.85), respectively. Initial time of ARV drugs use and HIV infection status of the sexual partner were not associated with maternal APOs.The findings of this study indicated that maternal HIV infection was associated with significantly increased risks of stillbirth, PTB, LBW and SGA, but not neonatal asphyxia or birth defects. On the condition that most HIV-infected pregnant women started ARV therapy in or after the second trimester, both mono/dual therapy and HAART had a protective effect on stillbirth compared with untreated HIV infection. As some important confounders were not effectively controlled and the specific regimens of HAART were not analyzed, the above findings may have certain bias.
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Affiliation(s)
- Huixia Li
- Department of Child Health Care
- NHC Key Laboratory of Birth Defects Research, Prevention and Treatment, Hunan Provincial Maternal and Child Health Care Hospital
| | | | | | | | - Jianfei Zheng
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University
| | | | - Hua Wang
- NHC Key Laboratory of Birth Defects Research, Prevention and Treatment, Hunan Provincial Maternal and Child Health Care Hospital
- Department of Maternal Health Care, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province
| | | | - Na Feng
- Department of Health Care, Shenzhen Nanshan Maternal and Child Health Care Hospital, Shenzhen, Guangdong Province
| | - Guoqiang Zhang
- Department of AIDS Prevention and Control, Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan Province, China
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Muyunda B, Musonda P, Mee P, Todd J, Michelo C. Effectiveness of Lifelong ART (Option B+) in the Prevention of Mother-to-Child Transmission of HIV Programme in Zambia: Observations Based on Routinely Collected Health Data. Front Public Health 2020; 7:401. [PMID: 32010656 PMCID: PMC6978742 DOI: 10.3389/fpubh.2019.00401] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 12/16/2019] [Indexed: 11/29/2022] Open
Abstract
Background: Mother to child transmission of HIV (MTCT) is a global challenge affecting many countries especially in sub-Saharan Africa. In 2009 about 370,000 infants were infected with HIV mainly through MTCT and most of them in sub-Saharan Africa. We aimed to determine the effectiveness of Option B+ compared to other options in reducing rates of early MTCT of HIV infections in Zambia. Methods: This was a retrospective cohort study based on routinely collected data using SmartCare in Zambia. Survival analysis with Cox Proportional Hazard regression was used to determine association between MTCT and regimen type of mothers. Kaplan-Meier (K-M) curves were used to compare MTCT for infants born to mothers option B+ to those on other options, and Wilcoxon (Breslow) test was used to establish statistical significance. Results: Overall (n = 1,444), mother-baby pairs with complete data were included in the analysis, with the median age of mothers being 33 (28–38) years; and 57% of these women were on Option B+. MTCT rate was estimated at 5% (73/1,444) [P = 0.025]. A Kaplan-Meier estimate showed that HIV Exposed Infants (HEI) of mothers on Option B+ had lower MTCT rate than those who were on other MTCT prevention interventions [Wilcoxon test; chi2 = 4.97; P = 0.025]. Furthermore, The Nelson Aalen cumulative hazard estimates indicated similar evidence of option B+ being more effective than other options with some statistical significance [HR = 0.63, P = 0.068]. HEI of option B+ mothers had 50% reduced risk of having HIV infection compared to option A/B [adjusted HR = 0.4; 95% CI = 0.28–0.84; P = 0.010]. HEI to women who were married had an increased risk 50% of getting infected compared to those not married [adjusted HR = 1.5; 95% CI = 3.43–6.30; P < 0.001]. Exposed infants whose mothers had assisted delivery had 3 times increased risk of getting infected compared to those born through normal vaginal delivery [Adjusted HR = 3.2; 95% CI = 0.98–10.21; P = 0.050]. Conclusions: The use of Option B+ as PMTCT intervention was found to be more effective in reducing MTCT of HIV compared to other options. Scaling up access to life-long ART and improving retention for women on treatment can potentially reduce further vertical transmission.
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Affiliation(s)
- Brian Muyunda
- Department of Epidemiology and Biostatistics, The University of Zambia School of Public Health, Lusaka, Zambia.,Ministry of Health, University Teaching Hospital, Lusaka, Zambia
| | - Patrick Musonda
- Department of Epidemiology and Biostatistics, The University of Zambia School of Public Health, Lusaka, Zambia
| | - Paul Mee
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jim Todd
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Charles Michelo
- Department of Epidemiology and Biostatistics, The University of Zambia School of Public Health, Lusaka, Zambia
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Yitayew YA, Bekele DM, Demissie BW, Menji ZA. Mother to Child Transmission of HIV and Associated Factors Among HIV Exposed Infants at Public Health Facilities, Dessie Town, Ethiopia. HIV AIDS (Auckl) 2019; 11:343-350. [PMID: 31849537 PMCID: PMC6913252 DOI: 10.2147/hiv.s221409] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 11/28/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Vertical transmission of Human Immunodeficiency Virus (HIV) is the primary route of infection among children. Ethiopia is among the top ten countries in the world with the highest burden of HIV infections among children. Therefore we aimed to assess mother to child transmission (MTCT) of HIV and associated factors among HIV exposed infants (HEIs). METHODS A cross-sectional study was conducted using retrospective data collected from HEIs paired with their mothers who had received the services in prevention of mother to child transmission (PMTCT) programs from January 2014 to December 2017 in public health facilities in Dessie town. Data of a total of 313 HEIs paired with their mothers were obtained by using semi-structured data extraction proforma from their medical records. The data were processed in Epi-info version 7.1.2.0 and analyzed using SPSS version 22. Crude and adjusted odds ratios with their 95% confidence intervals and p-value were used to identify significant factors. RESULTS The prevalence of HIV among exposed infants was 3.8%. Absence of maternal antenatal care visit (AOR = 4.6, 95% CI: 1.17-17.99), home delivery (AOR = 4.2, 95% CI: 1.04 -16.76), absence of antiretroviral intervention to the mother (AOR= 5.7, 95% CI: 1.10-29.36), and failure to initiate nevirapine prophylaxis for the infant (AOR = 5.3, 95% CI: 1.11 -25.44) were significant factors of MTCT of HIV. CONCLUSION Prevalence of MTCT of HIV was low (3.8%) in Dessie town public health facilities. Having ANC visit, delivery at health facility, maternal ARV drug intake, and infant ARV prophylaxis were the significant protective factors against MTCT of HIV. Promoting ANC service utilization among pregnant women and providing counseling as well as setting up linkage with PMTCT and giving ARV intervention to all HIV positive pregnant women and timely initiation of NVP prophylaxis to all HEIs should be recommended by the minister of health and health facilities.
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Affiliation(s)
- Yibeltal Asmamaw Yitayew
- Department of Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Daniel Mengistu Bekele
- School of Nursing and Midwifery, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Zeleke Argaw Menji
- School of Nursing and Midwifery, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
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Wang Q, Chan PL, Newman LM, Dou LX, Wang XY, Qiao YP, Su M, Chen XS, Jin X, Wang AL. Acceptability and feasibility of dual HIV and syphilis point-of-care testing for early detection of infection among pregnant women in China: a prospective study. BMJ Open 2018; 8:e020717. [PMID: 30366912 PMCID: PMC6224742 DOI: 10.1136/bmjopen-2017-020717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 07/28/2018] [Accepted: 08/08/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the feasibility and acceptability of using WHO prequalified combined dual HIV/syphilis rapid diagnostic tests (RDT) for same-day results in antenatal care (ANC) clinics. METHODS This is a pragmatic implementation study using quantitative approach to evaluate outcomes. Antenatal clinic attendees from 21 rural and urban township hospitals in two provinces of China were offered with free dual RDTs testing that included HIV and syphilis, in addition to the routine blood tests. Study outcomes included testing uptake before and during dual RDT use, test feasibility and acceptability among pregnant women. Regression model was used to assess acceptance of RDT testing. RESULTS In total, 1787 out of 1828 pregnant women attending ANC received the RDT testing. Testing uptake among pregnant women in their first and second trimester increased from 76.0% (2438/3269) using standard blood testing to 90.1% (1626/1787) with concurrent RDT use (χ2=197.1, p<0.001). Among 1787 pregnant women who received RDT tests, 98.3% (1757/1787) participants were given test result the same day. Positive proportions of HIV and syphilis screened with RDT were 0.06% (1/1787) and 1.0% (18/1787), respectively. Regression analysis indicated that women who did not receive syphilis or HIV testing before were less likely to accept dual RDT (OR 0.28, 95% CI 0.10 to 0.75). Acceptance for dual RDT testing at second or third antenatal visit was lower compared with the first visit (OR 0.37, 95% CI 0.15 to 0.94). CONCLUSION Combined dual HIV/syphilis RDT with same-day results increased uptake of HIV and syphilis testing among pregnant women at primary healthcare facilities. Given the diversity of testing capacities among health services especially in rural areas in China, the dual RDT kit is feasible tool to improve testing uptake among pregnant women.
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Affiliation(s)
- Qian Wang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Po-Lin Chan
- Division of Communicable Diseases, World Health Orgnization China Office, Beijing, China
| | - Lori M Newman
- Department of Reproductive Health Research, World Health Organization, Geneva, Swaziland
| | - Li-Xia Dou
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiao-Yan Wang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ya-Ping Qiao
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Min Su
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiang-Sheng Chen
- National Center for Sexually Transmitted Disease Control, Chinese Academy of Medical Science and Peking Union Medical College Institute of Dermatology, Nanjing, China
| | - Xi Jin
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ai-Ling Wang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
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Muyunda B, Musonda P, Mee P, Todd J, Michelo C. Educational Attainment as a Predictor of HIV Testing Uptake Among Women of Child-Bearing Age: Analysis of 2014 Demographic and Health Survey in Zambia. Front Public Health 2018; 6:192. [PMID: 30155454 PMCID: PMC6102411 DOI: 10.3389/fpubh.2018.00192] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 06/22/2018] [Indexed: 11/19/2022] Open
Abstract
Background: Globally, an estimated 150,000 children were newly infected with HIV in 2015, over 90% of them in Sub-Saharan Africa. In Zambia, ~500,000 babies are born to HIV positive mothers every year, and without intervention 40,000 of them would acquire the infection. Studies have shown a strong association between education and HIV prevalence, but in Zambia, this association has not been demonstrated. There is little published information on the association between educational attainment and HIV testing uptake among pregnant women, which is fundamental in understanding the mother to child transmission of HIV. This study investigated whether educational attainment was associated with uptake of HIV testing among women of reproductive age in Zambia. Methods: Data were taken from Zambia Demographic and Health Survey in 2014 (ZDHS14). The analysis consisted of all women aged 15–49 years, who responded to the question on HIV testing in the ZDHS. Multivariable logistic regression was used to determine whether educational attainment was associated with uptake of HIV testing among women of reproductive age in Zambia. Results: Educational attainment was strongly associated with HIV testing among 15,388 women of child bearing age [AOR 3.8, 95% CI 1.7–8.2; p = 0.001]. HIV testing differed greatly by socioeconomic social status with an increased uptake among women with higher wealth index [AOR 4.4, 95% CI 1.9–9.9; p = 0.001]. Additionally, HIV testing was observed to be higher among the older women 25–34 years compared to the young women 15–19 years [AOR 2.3, 95% CI 1.3–4.3; p = 0.007]. Conclusions: This study revealed educational attainment to be a strong predictor of HIV testing among women of child bearing age in this population. High HIV testing uptake among educated pregnant women indicated that low-educated women may not fully realize the benefits of testing for HIV. Therefore, strengthening HIV testing in rural health facilities and providing initiatives to overcome barriers to testing among women with no formal education may help reduce vertical transmission of HIV.
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Affiliation(s)
- Brian Muyunda
- Department of Epidemiology and Biostatistics, The University of Zambia School of Public Health, Lusaka, Zambia.,Ministry of Health, University Teaching Hospital, Lusaka, Zambia
| | - Patrick Musonda
- Department of Epidemiology and Biostatistics, The University of Zambia School of Public Health, Lusaka, Zambia
| | - Paul Mee
- Department of Epidemiology and Population Health, Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jim Todd
- Department of Epidemiology and Population Health, Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Charles Michelo
- Department of Epidemiology and Biostatistics, The University of Zambia School of Public Health, Lusaka, Zambia
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Fitting S, McLaurin KA, Booze RM, Mactutus CF. Dose-dependent neurocognitive deficits following postnatal day 10 HIV-1 viral protein exposure: Relationship to hippocampal anatomy parameters. Int J Dev Neurosci 2018; 65:66-82. [PMID: 29111178 PMCID: PMC5889695 DOI: 10.1016/j.ijdevneu.2017.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/16/2017] [Accepted: 10/23/2017] [Indexed: 11/25/2022] Open
Abstract
Despite the availability of antiretroviral prophylactic treatment, pediatric human immunodeficiency virus type 1 (HIV-1) continues to be a significant risk factor in the post-cART era. The time of infection (i.e., during pregnancy, delivery or breastfeeding) may play a role in the development of neurocognitive deficits in pediatric HIV-1. HIV-1 viral protein exposure on postnatal day (P)1, preceding the postnatal brain growth spurt in rats, had deleterious effects on neurocognitive development and anatomical parameters of the hippocampus (Fitting et al., 2008a,b). In the present study, rats were stereotaxically injected with HIV-1 viral proteins, including Tat1-86 and gp120, on P10 to further examine the role of timing on neurocognitive development and anatomical parameters of the hippocampus (Fitting et al., 2010). The dose-dependent virotoxin effects observed across development following P10 Tat1-86 exposure were specific to spatial learning and absent from prepulse inhibition and locomotor activity. A relationship between alterations in spatial learning and/or memory and hippocampal anatomical parameters was noted. Specifically, the estimated number of neurons and astrocytes in the hilus of the dentate gyrus explained 70% of the variance of search behavior in Morris water maze acquisition training for adolescents and 65% of the variance for adults; a brain-behavior relationship consistent with observations following P1 viral protein exposure. Collectively, late viral protein exposure (P10) results in selective alterations in neurocognitive development without modifying measures of somatic growth, preattentive processing, or locomotor activity, as characterized by early viral protein exposure (P1). Thus, timing may be a critical factor in disease progression, with children infected with HIV earlier in life being more vulnerable to CNS disease.
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Affiliation(s)
- Sylvia Fitting
- University of South Carolina, Behavioral Neuroscience Program, Department of Psychology, Columbia, SC 29208, USA; University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Kristen A McLaurin
- University of South Carolina, Behavioral Neuroscience Program, Department of Psychology, Columbia, SC 29208, USA
| | - Rosemarie M Booze
- University of South Carolina, Behavioral Neuroscience Program, Department of Psychology, Columbia, SC 29208, USA
| | - Charles F Mactutus
- University of South Carolina, Behavioral Neuroscience Program, Department of Psychology, Columbia, SC 29208, USA.
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