Impact of Timing of Antiretroviral Treatment and Birth Weight on Mother-to-Child Human Immunodeficiency Virus Transmission: Findings From an 18-Month Prospective Cohort of a Nationally Representative Sample of Mother–Infant Pairs During the Transition From Option A to Option B+ in Zimbabwe

Details

• Alternative Title:
  Clin Infect Dis
• Personal Author:
  Dinh, Thu-Ha ; Mushavi, Angela ; Shiraishi, Ray W. ; Barr, Beth Tippett ; Balachandra, Shirish ; Shambira, Gerald ; Nyakura, Justice ; Zinyowera, Sekesai ; Tshimanga, Mufuta ; Mugurungi, Owen ; Kilmarx, Peter H.
• Description:
  Background.
  
  Preventing mother-to-child transmission of human immunodeficiency virus transmission (MTCT) depends on early initiation of antiretroviral therapy (ART). We report the 18-month MTCT risk during the transition from Option A to Option B+ in Zimbabwe, and assess whether ART preconception could eliminate MTCT in breastfeeding populations.
  
  Methods.
  
  In 2013, we consecutively recruited a nationally representative sample of 6051 infants aged 4–12 weeks and their mothers from 151 immunization clinics using a multistage stratified cluster sampling method. We identified 1172 human immunodeficiency virus (HIV)–exposed infants and evaluated them at baseline and every 3 months until the child became HIV-infected, died, or reached age 18 months.
  
  Results.
  
  The cumulative MTCT risk through 18 months postdelivery was 7.0%. Of the HIV-infected mothers, 35.3% started ART preconception, 28.9% during pregnancy, and 9.7% after delivery, and 16.0% received zidovudine during pregnancy. Compared to mothers without antiretroviral drug use, MTCT among those starting ART preconception and during pregnancy was lower by 88% (adjusted hazard ratio [aHR], 0.12; 95% confidence interval [CI], .06–.24) and 75% (aHR, 0.25; 95% CI, .14–.45), respectively. HIV-exposed infants with birth weight <2.5 kg (low birth weight) were 2.6-fold more likely to acquire HIV infection compared to those with birth weight ≥2.5 kg (aHR, 2.57; 95% CI, 1.44–4.59). Controlling for other factors, breastfeeding was not significantly associated with MTCT.
  
  Conclusions.
  
  ART preconception has the highest impact on reducing MTCT, indicating that HIV-infected, reproductive-age women should be prioritized in “treat-all” strategies. HIV-infected mothers without ART use should be identified at the first immunization visit and treatment initiated to reduce postdelivery MTCT. MTCT risk is higher in mothers with low-birth-weight deliveries.
  
  
• Subjects:
  Adolescent Adult Anti-HIV Agents Birth Weight Breast Feeding Female HIV HIV Infections Humans Infant Infant, Newborn Infectious Disease Transmission, Vertical Mothers Pregnancy Pregnancy Complications, Infectious Prospective Studies Time Factors Zidovudine

  More +
• Source:
  Clin Infect Dis. 66(4):576-585
• Pubmed ID:
  29401270
• Pubmed Central ID:
  PMC8764936
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/ ; PEPFAR/PEPFARUnited States/
• Place as Subject:
  Zimbabwe
• Volume:
  66
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:cd158a9e8af262e898f2f74f7ec414c75c413965d1c9d596e30279b57666b6e4
• Download URL:
  https://stacks.cdc.gov/view/cdc/113490/cdc_113490_DS1.pdf
• File Type:
  [PDF - 1.10 MB ]