Maternal Highly Active Antiretroviral Therapy and Child HIV-free Survival in Malawi, 2004-2009
Published Date:Mar 2016
Source:Matern Child Health J. 20(3):542-549.
Antiretroviral Therapy, Highly Active
CD4 Lymphocyte Count
Highly Active Antiretroviral Therapy
Infectious Disease Transmission, Vertical
Pregnancy Complications, Infectious
Prevention Of Mother-to-child Transmission
Pubmed Central ID:PMC4754130
Funding:U50 PS022061/PS/NCHHSTP CDC HHS/United States
5 U50 PS022061-05/PS/NCHHSTP CDC HHS/United States
U50/CC0222061/CC/ODCDC CDC HHS/United States
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.
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.
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.
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.
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