BACKGROUND
Sub-saharan Africa remains to date at the forefront of the HIV/AIDS epidemic. Despite
breastfeeding being a significant mode of postnatal HIV transmission it remains the main
nutritional source and pillar of child survival for the majority of infants born in Africa. It is
therefore, not surprising that considerable research has centred on making breastfeeding
safer in terms of HIV transmission. The flash heat treatment method (HTEBM) provides a
unique opportunity to safely breastfeed infants but prevent mother-to-child transmission of
HIV. Cytotoxic T lymphocyte (CTL) responses have been well documented in HIVinfected
adults and children. However, there is a lack of literature on CTL responses in
HIV exposed low birth weight infants. This pilot study attempted to examine the
association of early neonatal feeding on the clinical outcomes and CTL responses in HIV
exposed low birth weight infants.
METHODS
Seventy-seven patients that fulfilled inclusion and exclusion criteria were enrolled. The
clinical outcomes of these patients were evaluated over a 9 month period. Fifty-five of
these patients were also investigated for cytotoxic T lymphocyte (CTL) responses by
means of the IFNγ ELISpot (megamatrix and confirmation) assays at the 6 weeks, 3, 6,and
9 months follow-up.
RESULTS
Two HIV-1 infected infants generated a CTL response at a single time point using the
ELISPOT matrix screening assay. These responses could not be confirmed and were
undetectable at any of the consecutive visits. At the time of detection of responses the
infants were fed unheated breastmilk. HIV-1 exposed uninfected infants were unable to
elicit a HIV-1-specific CTL response irrespective of feed. With regards to clinical
outcomes, infants born o HIV infected mothers with a CD4 count < 500cells/μl were 2x
more likely to acquire other infections at birth compared to those infants born to HIV
infected mothers with a CD4 count >500cells/μl. Also, infants born to HIV infected
mothers with advanced disease (CD4 count 0-200 cells/μl) had a lower birth weight
compared to infants born to HIV-1 infected mothers with a CD4 count > 350 cells/μl. We
also investigated the feasibility of the flash heat treatment method at birth. While inhospital,
38 HIV-1 infected women fed their infants HTEBM after receiving counseling
and support from the nursing staff at the King Edward VIII hospital. The numbers
decreased rapidly post hospital discharge, mainly due to mixed feeding.
DISCUSSION
In conclusion we have shown that it is feasible for HIV infected mothers to heat treat their
expressed breastmilk during hospital admission. Furthermore, we were able to demonstrate
in this small cohort of patients that the clinical outcomes and growth parameters of infants
fed HTEBM were similar to that of infants fed either formula or unheated breastmilk. We
were unable to demonstrate HIV-specific responses in the infected infants or the uninfected
infants who had been exposed to heat inactivated virus in HTEBM. Our findings indicate
that this pilot study was limited in its ability to detect CTL responses in HIV exposed low
birth weight infants and further studies are warranted. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2011.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:ukzn/oai:http://researchspace.ukzn.ac.za:10413/9654 |
| Date | January 2011 |
| Creators | Dassaye, Reshmi. |
| Contributors | Coutsoudis, Anna., Sunpath, Henry. |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
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