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Efficacy of WHO recommendation for continued breastfeeding and maternal cART for prevention of perinatal and postnatal HIV transmission in Zambia.

Ngoma MS, Misir A, Mutale W, Rampakakis E, Sampalis JS, Elong A, Chisele S, Mwale A, Mwansa JK, Mumba S, Chandwe M, Pilon R, Sandstrom P, Wu S, Yee K, Silverman MS - J Int AIDS Soc (2015)

Bottom Line: The cumulative rate of infant HIV infection or death at 18 months was 29/226 (12.8% 95 CI: 7.5-20.8%).Maternal cART may limit MTCT of HIV to the UNAIDS target of <5% for eradication of paediatric HIV within the context of a clinical study, but poor adherence to cART and follow-up can limit the benefit.Continued breastfeeding can prevent the rise in infant mortality after six months seen in previous studies, which encouraged early COB.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatrics and Child Health, University of Zambia, Lusaka, Zambia; Profngoma09@gmail.com.

ABSTRACT

Introduction: To prevent mother-to-child transmission (MTCT) of HIV in developing countries, new World Health Organization (WHO) guidelines recommend maternal combination antiretroviral therapy (cART) during pregnancy, throughout breastfeeding for 1 year and then cessation of breastfeeding (COB). The efficacy of this approach during the first six months of exclusive breastfeeding has been demonstrated, but the efficacy of this approach beyond six months is not well documented.

Methods: A prospective observational cohort study of 279 HIV-positive mothers was started on zidovudine/3TC and lopinavir/ritonavir tablets between 14 and 30 weeks gestation and continued indefinitely thereafter. Women were encouraged to exclusively breastfeed for six months, complementary feed for the next six months and then cease breastfeeding between 12 and 13 months. Infants were followed for transmission to 18 months and for survival to 24 months. Text message reminders and stipends for food and transport were utilized to encourage adherence and follow-up.

Results: Total MTCT was 9 of 219 live born infants (4.1%; confidence interval (CI) 2.2-7.6%). All breastfeeding transmissions that could be timed (5/5) occurred after six months of age. All mothers who transmitted after six months had a six-month plasma viral load >1,000 copies/ml (p<0.001). Poor adherence to cART as noted by missed dispensary visits was associated with transmission (p=0.04). Infant mortality was lower after six months of age than during the first six months of life (p=0.02). The cumulative rate of infant HIV infection or death at 18 months was 29/226 (12.8% 95 CI: 7.5-20.8%).

Conclusions: Maternal cART may limit MTCT of HIV to the UNAIDS target of <5% for eradication of paediatric HIV within the context of a clinical study, but poor adherence to cART and follow-up can limit the benefit. Continued breastfeeding can prevent the rise in infant mortality after six months seen in previous studies, which encouraged early COB.

No MeSH data available.


Related in: MedlinePlus

Transmission status follow-up on livebirths and survivors.†Three hundred and eighty-four pregnant women were approached, of which 80 were not eligible (due to presentation outside of 14–30 weeks gestation) and 25 declined enrolment, leaving 279 women who were recruited. Of the 279 enrolled women, 45 of 279 (15%) defaulted before birth, leaving 234 women. Of these 234 women, 8 had stillbirths and 226 had livebirths. These 226 mothers delivered 231 liveborn infants (five pairs of twins were included). *Two infants HIV positive at birth so no longer at-risk for transmission at start of time interval, therefore removed from denominator. **Infant became HIV positive+1 infant died between birth and 6 weeks, so no longer at-risk for transmission at start of time interval, therefore removed from denominator.
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Figure 0001: Transmission status follow-up on livebirths and survivors.†Three hundred and eighty-four pregnant women were approached, of which 80 were not eligible (due to presentation outside of 14–30 weeks gestation) and 25 declined enrolment, leaving 279 women who were recruited. Of the 279 enrolled women, 45 of 279 (15%) defaulted before birth, leaving 234 women. Of these 234 women, 8 had stillbirths and 226 had livebirths. These 226 mothers delivered 231 liveborn infants (five pairs of twins were included). *Two infants HIV positive at birth so no longer at-risk for transmission at start of time interval, therefore removed from denominator. **Infant became HIV positive+1 infant died between birth and 6 weeks, so no longer at-risk for transmission at start of time interval, therefore removed from denominator.

Mentions: Transmission status at follow-up is presented in Figure 1. Overall, when considering all 231 live births, HIV status was known at 18 months or at the last scheduled test interval before their death (whichever came first) for 201/231 (87.0%). There was no difference between the women who were lost to follow-up postpartum and those who completed 24 months of follow-up when compared by maternal age (p=0.55), maternal CD4 at birth (p=0.89) or infant GA at birth (p=0.946). A total of 9/219 (4.1%; 95% CI: 2.2–7.6%) infants acquired HIV during the study period. There was a trend towards a higher transmission rate/100 person-weeks during 6–18 months (0.0529/100 person-weeks) when compared to six weeks to six months (0/100 person-weeks; p=0.167).


Efficacy of WHO recommendation for continued breastfeeding and maternal cART for prevention of perinatal and postnatal HIV transmission in Zambia.

Ngoma MS, Misir A, Mutale W, Rampakakis E, Sampalis JS, Elong A, Chisele S, Mwale A, Mwansa JK, Mumba S, Chandwe M, Pilon R, Sandstrom P, Wu S, Yee K, Silverman MS - J Int AIDS Soc (2015)

Transmission status follow-up on livebirths and survivors.†Three hundred and eighty-four pregnant women were approached, of which 80 were not eligible (due to presentation outside of 14–30 weeks gestation) and 25 declined enrolment, leaving 279 women who were recruited. Of the 279 enrolled women, 45 of 279 (15%) defaulted before birth, leaving 234 women. Of these 234 women, 8 had stillbirths and 226 had livebirths. These 226 mothers delivered 231 liveborn infants (five pairs of twins were included). *Two infants HIV positive at birth so no longer at-risk for transmission at start of time interval, therefore removed from denominator. **Infant became HIV positive+1 infant died between birth and 6 weeks, so no longer at-risk for transmission at start of time interval, therefore removed from denominator.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4490793&req=5

Figure 0001: Transmission status follow-up on livebirths and survivors.†Three hundred and eighty-four pregnant women were approached, of which 80 were not eligible (due to presentation outside of 14–30 weeks gestation) and 25 declined enrolment, leaving 279 women who were recruited. Of the 279 enrolled women, 45 of 279 (15%) defaulted before birth, leaving 234 women. Of these 234 women, 8 had stillbirths and 226 had livebirths. These 226 mothers delivered 231 liveborn infants (five pairs of twins were included). *Two infants HIV positive at birth so no longer at-risk for transmission at start of time interval, therefore removed from denominator. **Infant became HIV positive+1 infant died between birth and 6 weeks, so no longer at-risk for transmission at start of time interval, therefore removed from denominator.
Mentions: Transmission status at follow-up is presented in Figure 1. Overall, when considering all 231 live births, HIV status was known at 18 months or at the last scheduled test interval before their death (whichever came first) for 201/231 (87.0%). There was no difference between the women who were lost to follow-up postpartum and those who completed 24 months of follow-up when compared by maternal age (p=0.55), maternal CD4 at birth (p=0.89) or infant GA at birth (p=0.946). A total of 9/219 (4.1%; 95% CI: 2.2–7.6%) infants acquired HIV during the study period. There was a trend towards a higher transmission rate/100 person-weeks during 6–18 months (0.0529/100 person-weeks) when compared to six weeks to six months (0/100 person-weeks; p=0.167).

Bottom Line: The cumulative rate of infant HIV infection or death at 18 months was 29/226 (12.8% 95 CI: 7.5-20.8%).Maternal cART may limit MTCT of HIV to the UNAIDS target of <5% for eradication of paediatric HIV within the context of a clinical study, but poor adherence to cART and follow-up can limit the benefit.Continued breastfeeding can prevent the rise in infant mortality after six months seen in previous studies, which encouraged early COB.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatrics and Child Health, University of Zambia, Lusaka, Zambia; Profngoma09@gmail.com.

ABSTRACT

Introduction: To prevent mother-to-child transmission (MTCT) of HIV in developing countries, new World Health Organization (WHO) guidelines recommend maternal combination antiretroviral therapy (cART) during pregnancy, throughout breastfeeding for 1 year and then cessation of breastfeeding (COB). The efficacy of this approach during the first six months of exclusive breastfeeding has been demonstrated, but the efficacy of this approach beyond six months is not well documented.

Methods: A prospective observational cohort study of 279 HIV-positive mothers was started on zidovudine/3TC and lopinavir/ritonavir tablets between 14 and 30 weeks gestation and continued indefinitely thereafter. Women were encouraged to exclusively breastfeed for six months, complementary feed for the next six months and then cease breastfeeding between 12 and 13 months. Infants were followed for transmission to 18 months and for survival to 24 months. Text message reminders and stipends for food and transport were utilized to encourage adherence and follow-up.

Results: Total MTCT was 9 of 219 live born infants (4.1%; confidence interval (CI) 2.2-7.6%). All breastfeeding transmissions that could be timed (5/5) occurred after six months of age. All mothers who transmitted after six months had a six-month plasma viral load >1,000 copies/ml (p<0.001). Poor adherence to cART as noted by missed dispensary visits was associated with transmission (p=0.04). Infant mortality was lower after six months of age than during the first six months of life (p=0.02). The cumulative rate of infant HIV infection or death at 18 months was 29/226 (12.8% 95 CI: 7.5-20.8%).

Conclusions: Maternal cART may limit MTCT of HIV to the UNAIDS target of <5% for eradication of paediatric HIV within the context of a clinical study, but poor adherence to cART and follow-up can limit the benefit. Continued breastfeeding can prevent the rise in infant mortality after six months seen in previous studies, which encouraged early COB.

No MeSH data available.


Related in: MedlinePlus