African infants’ CCL3 gene copies influence perinatal HIV transmission in the absence of maternal nevirapine

  • AIDS, Volume 21, No. 13, Year 2007

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Study Justification:
This study aimed to investigate the association between CCL3L1 gene copy numbers and perinatal HIV transmission in the absence of maternal nevirapine. Previous research has shown that individuals with more copies of CCL3L1 are less susceptible to HIV infection. Understanding the role of CCL3L1 gene copies in perinatal HIV transmission could provide valuable insights for prevention strategies.
Highlights:
– The study included 849 HIV-infected mothers and their infants from four cohorts in Johannesburg, South Africa.
– Maternal and infant CCL3L1 gene copy numbers were determined using real-time polymerase chain reaction.
– Higher numbers of infant CCL3L1 gene copies were associated with reduced HIV transmission.
– The association was attenuated if mothers took single-dose nevirapine or had low viral load.
– Maternal nevirapine was associated with reduced CCL3 production in cord blood mononuclear cells from uninfected infants.
Recommendations:
– Further research is needed to understand the mechanisms by which CCL3L1 gene copies influence perinatal HIV transmission.
– Strategies should be developed to identify infants with higher CCL3L1 gene copy numbers and provide targeted interventions for prevention.
– The role of nevirapine in modifying the relationship between CCL3L1 gene copies and perinatal HIV transmission should be investigated.
Key Role Players:
– Researchers and scientists specializing in HIV transmission and genetics.
– Healthcare professionals involved in perinatal HIV prevention and treatment.
– Policy makers and government officials responsible for implementing HIV prevention programs.
Cost Items for Planning Recommendations:
– Research funding for conducting further studies and investigations.
– Resources for genetic testing to determine CCL3L1 gene copy numbers in infants.
– Training and education programs for healthcare professionals on identifying and managing infants with higher CCL3L1 gene copy numbers.
– Development and implementation of targeted interventions for prevention.
– Monitoring and evaluation of the effectiveness of interventions.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study is a nested case-control study combining data from four cohorts, which provides a larger sample size. The association between higher infant CCL3L1 gene copies and reduced HIV transmission is statistically significant (P = 0.004). However, the association is attenuated if mothers took single-dose nevirapine or if the maternal viral load was low. To improve the strength of the evidence, the study could consider controlling for confounding factors such as maternal viral load and nevirapine usage. Additionally, replication of the findings in independent cohorts would further strengthen the evidence.

BACKGROUND: Individuals with more copies of CCL3L1 (CCR5 ligand) than their population median have been found to be less susceptible to HIV infection. We investigated whether maternal or infant CCL3L1 gene copy numbers are associated with perinatal HIV transmission when single-dose nevirapine is given for prevention. METHOD: A nested case-control study was undertaken combining data from four cohorts including 849 HIV-infected mothers and their infants followed prospectively in Johannesburg, South Africa. Access to antiretroviral drugs for the prevention of perinatal transmission differed across the cohorts. Maternal and infant CCL3L1 gene copy numbers per diploid genome (pdg) were determined by real-time polymerase chain reaction for 79 out of 83 transmitting pairs (∼10% transmission rate) and 235 randomly selected non-transmitting pairs. RESULTS: Higher numbers of infant, but not maternal, CCL3L1 gene copies were associated with reduced HIV transmission (P = 0.004) overall, but the association was attenuated if mothers took single-dose nevirapine or if the maternal viral load was low. Maternal nevirapine was also associated with reduced spontaneously released CCL3 (P = 0.007) and phytohemagglutinin- stimulated CCL3 (P = 0.005) production in cord blood mononuclear cells from uninfected infants. CONCLUSION: We observed a strong association between higher infant CCL3L1 gene copies and reduced susceptibility to HIV in the absence of maternal nevirapine. We also observed a reduction in newborn CCL3 production with nevirapine exposure. Taken together, we hypothesize that nevirapine may have direct or indirect effects that partly modify the role of the CCR5 ligand CCL3 in HIV transmission, obscuring the relationship between this genetic marker and perinatal HIV transmission. © 2007 Lippincott Williams & Wilkins, Inc.

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The provided information is a research study titled “African infants’ CCL3 gene copies influence perinatal HIV transmission in the absence of maternal nevirapine.” The study investigates the association between CCL3L1 gene copy numbers and perinatal HIV transmission when single-dose nevirapine is used for prevention. The study found that higher numbers of infant CCL3L1 gene copies were associated with reduced HIV transmission. Additionally, maternal nevirapine was associated with reduced CCL3 production in cord blood mononuclear cells from uninfected infants. The researchers hypothesize that nevirapine may modify the role of CCL3 in HIV transmission, affecting the relationship between this genetic marker and perinatal HIV transmission.
AI Innovations Description
The provided description discusses a study that investigated the association between CCL3L1 gene copy numbers and perinatal HIV transmission in the presence or absence of maternal nevirapine. The study found that higher numbers of infant CCL3L1 gene copies were associated with reduced HIV transmission, particularly in the absence of maternal nevirapine. Additionally, maternal nevirapine was associated with reduced CCL3 production in newborns. The study suggests that nevirapine may have effects that modify the role of CCL3 in HIV transmission. This information can be used as a recommendation to develop an innovation to improve access to maternal health by considering the genetic factors that influence perinatal HIV transmission and the impact of antiretroviral drugs like nevirapine.
AI Innovations Methodology
Based on the provided description, it seems that you are looking for innovations to improve access to maternal health. However, the description you provided is a research study on the association between CCL3L1 gene copies and perinatal HIV transmission. It does not directly relate to innovations for improving access to maternal health.

To provide recommendations for innovations to improve access to maternal health, we would need more information on the specific challenges or areas that need improvement. However, here are a few general innovations that have been implemented to improve access to maternal health:

1. Telemedicine: Using technology to provide remote consultations, monitoring, and support for pregnant women in remote or underserved areas.
2. Mobile health (mHealth) applications: Developing mobile apps that provide information, reminders, and guidance on prenatal care, nutrition, and postpartum care.
3. Community health workers: Training and deploying community health workers to provide education, prenatal care, and support to pregnant women in their communities.
4. Maternal waiting homes: Establishing safe and affordable accommodations near health facilities where pregnant women can stay during the final weeks of pregnancy, ensuring access to skilled care during childbirth.
5. Transportation solutions: Implementing transportation services or vouchers to help pregnant women reach healthcare facilities for prenatal visits and delivery.

Regarding the methodology to simulate the impact of these recommendations on improving access to maternal health, a possible approach could include the following steps:

1. Define the target population: Identify the specific group or region for which the simulation will be conducted (e.g., rural communities, low-income areas).
2. Collect baseline data: Gather relevant data on the current state of maternal health access in the target population, including factors such as distance to healthcare facilities, availability of healthcare providers, and utilization rates.
3. Model the interventions: Develop a simulation model that incorporates the recommended innovations, taking into account factors such as the number of telemedicine consultations, the coverage of mobile health apps, the number of community health workers, etc.
4. Input data and assumptions: Input the collected baseline data into the simulation model and make assumptions about the potential impact of the interventions (e.g., increased utilization rates, reduced travel time).
5. Run simulations: Run the simulation model multiple times, varying the input parameters and assumptions to assess different scenarios and potential outcomes.
6. Analyze results: Analyze the simulation results to evaluate the potential impact of the recommended innovations on improving access to maternal health. This could include metrics such as increased utilization rates, reduced travel time, and improved health outcomes.
7. Refine and validate: Refine the simulation model based on feedback and validate the results against real-world data, if available.
8. Communicate findings: Present the findings of the simulation study to stakeholders, policymakers, and healthcare providers to inform decision-making and potential implementation of the recommended innovations.

It’s important to note that the specific methodology may vary depending on the available data, resources, and the complexity of the interventions being simulated.

Statistics:
Citations: 55
Authors: 8
Identifiers:
DOI: 10.1097/QAD.0b013e3282ba553a
ISSN: 02699370
Research Areas:
Community Interventions, Genetics and Genomics, Health System and Policy, Infectious Diseases, Maternal and Child Health
Study Countries:
South Africa
Study Design:
Case-Control Study, Cohort Study, Cross Sectional Study
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