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Male partner HIV-1 testing and antenatal clinical attendance associated with reduced infant HIV-1 acquisition and mortality
Presented by Adam Aluisio (United States).
A. Aluisio1, R. Bosire2, G. John-Stewart3, D. Mbori-Ngacha4, C. Farquhar5
1National Instititues of Health, Fogarty International Center, Bethesda, United States, 2Kenya Institute of Medical Research (KEMRI), Nairobi, Kenya, 3University of Washington, Departments of Medicine, Epidemiology and Global Health, Seattle, United States, 4University of Nairobi, Department of Pediatrics, Nairobi, Kenya, 5University of Washington, Departments of Medicine and Epidemiology, Seattle, United States
Background: The impact of male partners on infant HIV-1 outcomes and mortality has not been well described. This study determined factors affecting male partners' study attendance and their role in vertical transmission and mortality.
Methods: From 1999 to 2003, HIV-1-infected pregnant women were enrolled and followed with their infants. Women were encouraged to invite male partners for clinical attendance and HIV-1 testing. Mother-infant pairs were seen monthly and infant HIV-1 RNA and DNA PCR were conducted at birth, 1, 3, 6, 9 and 12 months postpartum.
Results: Among 456 women enrolled, partners of 140 (31%) attended the study, 75 (54%) of whom were tested and 42 (56%) of these men were HIV-1-seropositive. Male partner attendance was associated with female serostatus disclosure, partner PMTCT discussion and woman reporting prior partner HIV-1 testing. In multivariate analysis only previous HIV-1 testing remained significantly associated with attendance (AOR=19.6; 95%CI: 9.6-40.0; p=< 0.001). Eighty-two (16%) of 441 infants followed acquired HIV-1 by 12 months of age, with 27 (33%) infected by 48 h postpartum. When adjusting for maternal viral load and breast milk exposure, male partner attendance was associated with an approximately 50% reduction in HIV-1 transmission risk at one year postpartum (AOR=0.48; 95%CI: 0.24-0.95; p=0.04). Women reporting previous male partner HIV-1 testing were also less likely to transmit (AOR=0.32; 95% CI: 0.15-0.67; p=0.002). At one year, controlling for maternal viral load and breast milk exposure, infant HIV-1-free survival was ~60% greater among infants of women whose partners attended (AHR=0.43; 95%CI: 0.29-0.96; p=0.04) or had previously undergone HIV-1 testing (AHR=0.40; 95%CI: 0.20-0.79; p=0.008). Among 374 HIV-1-uninfected infants whose mothers had male partner clinical attendance, survival was 2.5-fold higher than those without (HR=0.38; 95%CI: 0.14- 0.98; p=0.045).
Conclusions: Male partner HIV-1 testing and clinical study attendance were associated with reduced vertical transmission, increased HIV-1-free survival, and reduced mortality for HIV-1-uninfected infants.
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