Preparations for AIDS vaccine evaluations. Rate of new HIV infection in a cohort of women of childbearing age in Malawi.

Abstract:

:Women attending the Queen Elizabeth Central Hospital in Blantyre, Malawi, between November 1989 and October 1993 were studied as part of a longitudinal cohort study of mother-to-infant HIV transmission. 694 HIV-seropositive and 687 HIV-seronegative women were enrolled at delivery. In the follow-up phase, women attended the clinic every 3 months for the first 24 months and every 6 months thereafter, where they were administered a questionnaire and underwent pelvic exam for the diagnosis of sexually transmitted diseases. HIV testing was performed by ELISA and Western Blotting. A nested case-control study was performed to identify risk factors for HIV seroconversion, and for each seroconverter, 2 seronegative women were selected. A total of 43 women seroconverted in the follow-up period. The rate of new HIV infection increased in the first 24 months postpartum. Postpartum rates were 1.42, 1.70, 2.43, and 4.33 per 100 person-semesters, respectively, in each of the first 4 semesters, which corresponded to annual seroconversion rates of 2.84 per 100 person-years in the 1st year and 6.66 in the 2nd year postpartum. Only 2.2% of the women reported sexual contact in the first 6 weeks postpartum, increasing to 57.6% in the period of 6 weeks to 6 months and to 86.5% in the period 7-12 months postpartum. Univariate analysis indicated the largest risk factor for HIV seroconversion as reported condom use (odds ratio [OR] = 5.67). Other factors included young age and low parity (OR = 2.90 and 2.77, respectively), a short interval between the birth of the study infant and a subsequent conception (OR = 4.20), and vaginal infection with Trichomonas vaginalis (OR = 3.4). Other factors with nonsignificant association with HIV seroconversion included: 1) genital ulcerations with a fourfold higher risk, 2) visible genital warts with a threefold increase, 3) hormone-containing contraceptives and cervical ectopy (OR = 1.13 and 1.07, respectively), and 4) vaginal irritants. Syphilis, cervical human papilloma virus, and cervical gonococcal infection were not associated with HIV seroconversion.

authors

Miotti P,Canner J,Chiphangwi J,Liomba G,Saah A,Dallabetta G

subject

Has Abstract

pub_date

1994-01-01 00:00:00

pages

S239-41

eissn

0889-2229

issn

1931-8405

journal_volume

10 Suppl 2

pub_type

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