A Case Series of 104 Women Infected with HIV

A Case Series of 104 Women Infected with HIV-1 via Blood Transfusion Postnatally: High Rate of HIV-1 Transmission to Infants through Breast-Feeding.

Liang and colleagues investigated transmission of human immunodeficiency virus type 1 (HIV-1) via breast-feeding by 104 Chinese mothers who acquired the infection through blood transfusion postnatally. Of 106 children, 38 (35.8%) were infected. All children survived to age 5 years, and their survival curve was similar to that of their mothers. These findings suggest a high rate of HIV-1 transmission via breast-feeding when mothers were infected postnatally via blood transfusion, perhaps because of the higher viremia expected during the acute phase of infection. The course of disease among infected children was significantly less rapid than that among newborns infected perinatally, suggesting that a brief window of HIV-1-free life often enables the immune system of an infant to stave off rapid disease progression.

Editors’ note: Although blood-selling practices were officially prohibited in China by 1995 and the Blood Transfusion Law was passed in 1998, some of the women in this cohort were infected by blood transfusions as late as 2000. This emphasises the importance of concrete local plans to reduce the time between the announcement of policies and their implementation. In this case study series of acutely infected, breastfeeding women, the HIV transmission rate of 35.8% was considerably higher than previous estimates of 9 to 16% for post-natal transmission through breast milk. The risk of HIV transmission rose significantly to 62.5% (95%CI, 35.4-84.9%) if mastitis or cracked nipples were reported. The low mortality rate of 13.2% in these children after a mean of 9.1 years in the absence of antiretroviral treatment suggests rapid evolution in the immune system capacity over the initial weeks and months of life leading to better viral control.