Published online February 1, 2005
PEDIATRICS Vol. 115 No. 2 February 2005, pp. e167-e172 (doi:10.1542/peds.2004-1590)
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ELECTRONIC ARTICLE

Gender Differences in Perinatal HIV Acquisition Among African Infants

Taha E. Taha, MBBS, PhD*, Samah Nour, MBChB*, Newton I. Kumwenda, PhD*, Robin L. Broadhead, MBBS, FRCP{ddagger}, Susan A. Fiscus, PhD§, George Kafulafula, MBBS, FCOG{ddagger}, Chiwawa Nkhoma, MSc||, Shu Chen, MSc* and Donald R. Hoover, PhD

* Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
{ddagger} College of Medicine, University of Malawi, Blantyre, Malawi
§ Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina
|| Johns Hopkins University–College of Medicine Research Project, University of Malawi, Blantyre, Malawi
Department of Statistics and Institute for Health, Health Care Policy, and Aging Research, Rutgers University, Piscataway, New Jersey

Objective. We investigated gender-specific risks of mother-to-child transmission (MTCT) at birth and at 6 to 8 weeks among infants born to HIV-infected African women.

Design. Follow-up study of infants enrolled in 2 randomized, phase III, clinical trials to prevent MTCT, conducted in Blantyre, Malawi, in southeast Africa.

Methods. Infants were enrolled at birth and monitored postnatally, and their HIV status was assessed at birth and at 6 to 8 weeks (assessment beyond 6–8 weeks is ongoing). Statistical analyses were stratified according to gender, and comparisons were made with descriptive, univariate, and multivariate statistical tests. MTCT was estimated at birth and at 6 to 8 weeks among infants who were not infected at birth.

Results. Overall, 966 boys and 998 girls were enrolled. The rate of HIV transmission at birth was 9.5% (187 of 1964 infants). However, at birth significantly more girls (12.6%) than boys (6.3%) were infected with HIV. This association remained significant after controlling for maternal viral load and other factors. Among infants who were uninfected at birth, 8.7% (135 of 1554 infants) acquired HIV by 6 to 8 weeks; of these infants, more girls acquired HIV (10.0%), compared with boys (7.4%).

Conclusions. Female infants may be more susceptible to HIV infection before birth and continuing after birth. Alternatively, in utero mortality rates of HIV-infected male infants may be disproportionately higher and thus more HIV-infected female infants are born. In areas of sub-Saharan Africa, where HIV infection rates are high among women of reproductive age, the magnitude of the gender transmission differences observed in this study could have clinical, preventive, and demographic implications.

Key Words: acquisition • Africa • gender • HIV • mother-to-child transmission • susceptibility

Abbreviations: MTCT, mother-to-child transmission • CI, confidence interval • NVP, nevirapine • ZDV, zidovudine

Accepted Sep 21, 2004.


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