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

Details

• Alternative Title:
  Matern Child Health J
• Personal Author:
  Schwartz, Sheree R. ; Kumwenda, Newton ; Kumwenda, Johnstone ; Chen, Shu ; Mofenson, Lynne M. ; Taylor, Allan W. ; Fowler, Mary Glenn ; Taha, Taha E.
• 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:
  • HIV-1
  • prevention of mother-to-child transmission
  • highly active antiretroviral therapy
  • child survival
  • breastfeeding
  • Adult
  • Antiretroviral Therapy, Highly Active
  • Breast Feeding
  • CD4 Lymphocyte Count
  • Female
  More +
• 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/
• Volume:
  20
• Issue:
  3
• Download URL:
  https://stacks.cdc.gov/view/cdc/38065/cdc_38065_DS1.pdf
• File Type:
  [PDF - 495.06 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:a4179a439f4e685847ef6e316400ed5842fe86f0f84e0ff0ee8fe1c76970d0f2