Maternal Highly Active Antiretroviral Therapy and Child HIV-free Survival in Malawi, 2004-2009

Schwartz, Sheree R.; Kumwenda, Newton; Kumwenda, Johnstone; Chen, Shu; Mofenson, Lynne M.; Taylor, Allan W.; Fowler, Mary Glenn; Taha, Taha E.

doi:10.1007/s10995-015-1852-5

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Maternal Highly Active Antiretroviral Therapy and Child HIV-free Survival in Malawi, 2004-2009

3 2016
By Schwartz, Sheree R. ; Kumwenda, Newton ; Kumwenda, Johnstone ; ...
http://dx.doi.org/10.1007/s10995-015-1852-5
Source: Matern Child Health J. 20(3):542-549

[PDF-495.06 KB]

English

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Details:

Alternative Title:

Matern Child Health J
Personal Author:

Schwartz, Sheree R. ; Kumwenda, Newton ; Kumwenda, Johnstone ; Chen, Shu ; Mofenson, Lynne M. ; ... More +

Schwartz, Sheree R. ; Kumwenda, Newton ; Kumwenda, Johnstone ; Chen, Shu ; Mofenson, Lynne M. ; Taylor, Allan W. ; Fowler, Mary Glenn ; Taha, Taha E. Less -
Description:

Objectives

Highly active antiretroviral therapy (HAART) provision to eligible HIV-infected pregnant and post-partum women is critical for optimizing maternal health. We assessed the impact of maternal HAART on HIV-free survival of breastfed infants in Malawi.

Methods

The Post-Exposure Prophylaxis of Infants (PEPI)-Malawi trial (2004-2009) enrolled mothers/infants during labor or immediately post-partum to evaluate 14-week extended infant antiretroviral prophylaxis for preventing HIV transmission through breastfeeding. Mothers meeting national HAART guidelines were referred for therapy. Child HIV-free survival--survival without HIV infection --was compared by maternal HAART status.

Results

Overall, 3,022 mother-infant pairs contributed 4,214 infant/person-years (PY) at-risk for HIV infection or death, with 532 events (incidence 12.6/100 PY, 95% confidence interval [CI] 11.6-13.7). During follow-up, 349 mothers were HAART initiated; 581 remained HAART naïve with CD4 cell counts <250 cells/mm3, and 2,092 were never HAART-eligible. By three months, 11% of infants with HAART naïve mothers (CD4<250) were infected with HIV or died versus 7% of infants of HAART-initiated mothers and 4% of infants of HAART-ineligible mothers. Maternal HAART was associated with a 46% reduction in infant HIV infection or death as compared to infants with HAART naïve mothers (CD4<250) (adjusted Hazards Ratio: 0.54,95% CI 0.36-0.81). Among HIV-exposed, uninfected infants, breastfeeding, but not HAART, was significantly associated with decreased child mortality.

Conclusions

HIV infection and mortality are high during the first 3 months post-partum in infants of mothers with advanced HIV, and rapid maternal HAART initiation can significantly improve HIV-related infant outcomes.
Keywords:

[+]

Adult Antiretroviral Therapy, Highly Active Breastfeeding Breast Feeding CD4 Lymphocyte Count Child Survival Female Follow-Up Studies Highly Active Antiretroviral Therapy HIV-1 HIV Infections Humans Infant Infectious Disease Transmission, Vertical Malawi Mothers Postpartum Period Pregnancy Pregnancy Complications, Infectious Pregnancy Outcome Prevention Of Mother-to-child Transmission Survival Analysis Time Factors Treatment Outcome Young Adult
Source:

Matern Child Health J. 20(3):542-549
Pubmed ID:

26525557
Pubmed Central ID:

PMC4754130
Document Type:

Journal Article
Funding:

U50 PS022061/PS/NCHHSTP CDC HHSUnited States/ ; 5 U50 PS022061-05/PS/NCHHSTP CDC HHSUnited States/ ; U50/CC0222061/CC/ODCDC CDC HHSUnited States/

U50 PS022061/PS/NCHHSTP CDC HHSUnited States/ ; 5 U50 PS022061-05/PS/NCHHSTP CDC HHSUnited States/ ; U50/CC0222061/CC/ODCDC CDC HHSUnited States/ Less -
Volume:

20
Issue:

3
Collection(s):

CDC Public Access
Main Document Checksum:

[+]

urn:sha256:a4179a439f4e685847ef6e316400ed5842fe86f0f84e0ff0ee8fe1c76970d0f2
Download URL:

https://stacks.cdc.gov/view/cdc/38065/cdc_38065_DS1.pdf
File Type:

	nihms-735097-f0001.gif	gif
	nihms-735097-f0001.jpg	jpeg
	nihms-735097.nxml	xml

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