Neonatal HIV 28 September 2004
Previous Rapid Response Next Rapid Response Top
Nicholas Bennett,
Infectious Disease Postdoc/Clinician
Department of Pediatrics, University Hospital, Syracuse NY

Send response to journal:
Re: Neonatal HIV

Mr Bartlett is quite right about the maternal antibodies being a problem. DNA-based PCR can be used (as opposed to the less specific but more sensitive RT-PCR of viral load) as well as viral culture, but that latter technique takes several weeks to get a result.

Two negative results at least two weeks apart by three months are the criteria here. Negative infants are followed up until their antibodies disappear, usually at 9 months. One case did go on to 17 months here, but his western blots were getting fainter and fainter over time and he was negative by PCR throughout.

The efficacy of treatment, as with any treatment, is impossible to say with clinical trials. PACTG 076 clearly showed the usefulness of AZT (the current standard of care). The regimen however is relatively expensive and difficult. HIVNET 012 showed that Nevirapine was more effective and much cheaper, and much simpler than AZT. However liver toxicity is limiting its use at this time. Caesarian sections are about as effective as AZT, and not breast feeding also contributes significantly.

I can't find a Semba Lancet article from 1995 but the one from 1994 states only that vitamin A deficiency promotes HIV transmission [1]. This isn't quite the same as saying that giving supplements would prevent the illness, but I concede that it's a reasonable assumption - one that needs formal testing. However, since vitamin A is a teratogen, excess supplementation could be far more deleterious to the fetus than the relative risk of HIV infection.

Interestingly vitamin A can affect the HIV replication efficiency in vivo [2]: leading one to wonder whether the deficiency seen in HIV+ mothers (perhaps due to their HIV status, as suggested by Semba) has a feedforward loop whereby the infection is less well controlled, and therefore the virus is more likely to infect the fetus.

Refs

1. Semba RD, et al. Maternal vitamin A deficiency and mother-to- child transmission of HIV-1. Lancet 1994;343:15931597.

2. Maciaszek et al J Virol. 1998 Jul;72(7):5862-9. Retinoid-induced repression of human immunodeficiency virus type 1 core promoter activity inhibits virus replication.

Competing interests: None declared