TY  - JOUR
AB  - INTRODUCTION: Despite global reductions in vertical HIV transmission (VHT), 120,000 children newly acquired HIV in 2023. High maternal viral load (VL) is a major risk factor for VHT. We estimated the impact of point-of-care (PoC) maternal VL testing at delivery in profiling the risk of VHT and its impact on appropriate postnatal prophylaxis for infants born to women living with HIV (WLWH). METHODS: The cluster-randomized LIFE (Long term Impact on inFant hEalth) study was conducted at 28 health facilities in Tanzania and Mozambique from 2019 to 2021. At delivery, the intervention arm applied PoC maternal VL plus clinical criteria for VHT risk assessment, while the control arm used clinical criteria only. In Tanzania, both arms provided ePNP based on maternal risk factors, while Mozambique provided ePNP universally. We used mixed effects logistic regression to estimate the intervention effect on the proportion of infants at high risk (Tanzania and Mozambique) and infants at high risk receiving ePNP (Tanzania only). RESULTS: A total of 6467 WLWH were enrolled: 66.3% were diagnosed before the third trimester, 99% were on antiretroviral therapy and 78% were virally suppressed at delivery. Of 6564 newborns of WLWH included, 774 (11.7%) were identified to be at a high risk: 629 (19.3%) versus 145 (4.4%) in intervention and control arms, respectively; p<0.0001. In the intervention arm, 520 (82.7%) infants at high risk were classified only based on maternal PoC VL at delivery. In the control arm, 720 (21.8%) additional infants at high risk would have been identified if their mothers had received PoC VL assessment. In Tanzania, infants at high risk in the intervention arm were significantly more likely to receive ePNP: 59.5% versus 31.4% (OR 4.42, 95% CI: 1.09, 17.89). However, 40.5% from intervention arm and 68.6% from control arm did not receive ePNP despite high-risk classification at delivery. CONCLUSIONS: PoC maternal VL testing at delivery significantly increased the proportion of infants identified to be at high risk. Infants at high risk whose mothers received PoC VL at delivery were more often initiated on ePNP. However, the linkage of infants at high risk to appropriate prophylaxis remains suboptimal, warranting consideration of universal ePNP.
AU  - Lwilla, A.F.*
AU  - Elsbernd, K.*
AU  - Boniface, S.*
AU  - Edom, R.*
AU  - Mahumane, A.*
AU  - Meggi, B.*
AU  - Buck, W.C.*
AU  - Lequechane, J.*
AU  - Pereira, K.*
AU  - Chiwerengo, N.*
AU  - Chale, F.*
AU  - Mudenyanga, C.*
AU  - Mutsaka, D.*
AU  - Mueller, M.*
AU  - Ntinginya, N.E.*
AU  - Taveira, N.*
AU  - Hoelscher, M.
AU  - Jani, I.V.*
AU  - Kroidl, A.*
AU  - Sabi, I.*
C1  - 75243
C2  - 57878
CY  - The Atrium, Southern Gate, Chichester Po19 8sq, W Sussex, England
TI  - Impact of point-of-care maternal viral load testing at delivery on vertical HIV transmission risk assessment and neonatal prophylaxis: A cluster randomized trial.
JO  - J. Int. AIDS Soc.
VL  - 28
IS  - 8
PB  - John Wiley & Sons Ltd
PY  - 2025
SN  - 1758-2652
ER  - 

TY  - JOUR
AB  - Bolduan S et al; licensee International AIDS Society. Introduction: Restriction factors (RFs) suppress HIV-1 in cell lines and primary cell models. Hence, RFs might be attractive targets for novel antiviral strategies, but their importance for virus control in vivo is controversial. Methods: We profiled the expression of RFs in primary blood-derived mononuclear cells (PBMC) from therapy-naïve HIV-1 patients and quantified infection. Results: Overall, there was no correlation between individual RF expression and HIV-1 status in total PBMC. However, we identified a T cell population with low levels of intracellular CD2 and reduced expression of SAMHD1, p21 and SerinC5. CD2 low T cells with reduced RF expression were markedly positive for HIV-1 p24. In contrast, CD2+ T cells were less infected and expressed higher levels of RFs. CD2 low T cell infection correlated with viral loads and was associated with HIV-1 disease progression. Conclusions: In untreated therapy naïve chronic HIV-1 patients, RF expression in T cells is associated with CD2 expression and seems to influence viral loads. Our study suggests that RFs help to control HIV-1 infection in certain T cells in vivo and supports the potential for RFs as promising targets for therapeutic intervention.
AU  - Bolduan, S.
AU  - Koppensteiner, H.
AU  - Businger, R.*
AU  - Rebensburg, S.
AU  - Kunze, C.
AU  - Brack-Werner, R.
AU  - Draenert, R.*
AU  - Schindler, M.
C1  - 51997
C2  - 43633
CY  - Geneva
TI  - T cells with low CD2 levels express reduced restriction factors and are preferentially infected in therapy naïve chronic HIV-1 patients.
JO  - J. Int. AIDS Soc.
VL  - 20
IS  - 1
PB  - Int Aids Society
PY  - 2017
SN  - 1758-2652
ER  -