Acute HIV infection and pregnancy

由马里兰大学人类病毒学研究所领导的由研究人员组成的合作小组 (IHV)将确定115名患有急性艾滋病毒感染的孕妇。我们的长期目标是推进 艾滋病病毒感染者母婴传播风险的了解 怀孕了。采用HIV快速检测和多阶段混合核酸扩增相结合的方法 检测，来自尼日利亚的孕妇将在病毒抗原血症窗口期间和之前登记 确证抗体阳性的发展。本研究拓展了对早期宿主病毒的认识 在预防母婴传播(防止母婴传播)的背景下进行互动，以满足具体的预防需要。 我们假设，在以下情况下，孕妇中的急性艾滋病毒感染被低估了 预防母婴传播计划，其特点是与被低估的阴道感染有关 在怀孕期间。产妇急性艾滋病毒感染可能增加母婴传播的风险并影响病毒选择 与长期存在的艾滋病毒感染相比。尼日利亚独特的艾滋病毒亚型主要表现为 G亚型和CRF02_AG也可改变传播风险。为了检验这些相互关联的假设，我们 建议：(1)确定孕妇急性HIV感染的发病率及相关因素；(2) 评估急性艾滋病毒感染、艾滋病毒亚型和母婴传播之间的关系，以及 (3)使用单基因组扩增来比较MTCT中存在的遗传选择水平与 急性和长期的孕产妇艾滋病毒感染。虽然令人信服的证据表明 检测母体感染艾滋病毒的重要性，但对此的关注却很少 进球。毫不奇怪，急性艾滋病毒期间的MTCT及其与抗逆转录病毒预防效果的关系 没有经过评估。这一建议将为二次艾滋病毒感染提供一个独特的视角(即从急性 在母婴传播和母婴传播的情况下 致病机制包括早期宿主与病毒的相互作用。它还解决了失去机会的问题 针对患有急性感染的孕妇的预防，否则常规方法会遗漏这些感染 基于抗体的检测策略。最后，及早认识到艾滋病病毒的治疗可能会改变 这种疾病的自然病史。总而言之，这项提议将允许令人兴奋的流行病学、临床和 公共卫生研究机会。

A collaborative team involving investigators led by the Institute of Human Virology-University of Maryland (IHV) will identify 115 pregnant women with acute HIV infection. Our long-term goal is to advance the understanding of mother-to-child transmission (MTCT) risk in women who acquired HIV infection during pregnancy. Employing a combination of rapid HIV assays and multi-stage pooled nucleic acid amplification tests, pregnant women from Nigeria will be enrolled during the window of viral antigenemia and prior to development of confirmatory antibodies positivity. This research extends the knowledge of early host-virus interaction to address the specific prevention needs within the context of the prevention of MTCT (PMTCT). We hypothesize that acute HIV infection among pregnant women is underestimated within the setting of PMTCT program and is characterized by its association with vaginal infections that are under-diagnosed during pregnancy. Maternal acute HIV infection could increase the risk of MTCT and affect viral selection compared to long-standing HIV infection. The unique HIV subtypes in Nigeria characterized predominantly by subtype G and CRF02_AG could also alter the transmission risk. To test these interlocking hypotheses, we propose to: (1) determine the incidence rate and correlates of acute HIV infection among pregnant women, (2) evaluate the associations between acute HIV infection, HIV subtypes, and mother-to-child transmission, and (3) use single genome amplification to compare the level of genetic selection present in MTCT in relations to acute and long-standing maternal HIV infection. While compelling evidences suggest the potential importance of detecting incident maternal HIV infection, remarkably little attention has been devoted to this goal. Not surprisingly, MTCT during acute HIV and its relation to the effect of antiretroviral prophylaxis has not been evaluated. This proposal will provide a unique view of secondary HIV infection (i.e. from an acutely infected index case to a susceptible individual) within the context of mother-to-child transmission and of pathogenesis including early host-virus interactions. It also tackles the issue of ¿missed opportunity¿ for prevention directed at pregnant women with acute infection that would otherwise be missed by conventional antibody-based testing strategies. Lastly, very early recognition may allow for HIV treatment that could alter the natural history of the disease. All in all, this proposal will permit exciting epidemiological, clinical, and public health research opportunities.