Antiretroviral treatment and prevention of peripartum and postnatal HIV transmission in West Africa: evaluation of a two-tiered approach.Report as inadecuate

Antiretroviral treatment and prevention of peripartum and postnatal HIV transmission in West Africa: evaluation of a two-tiered approach. - Download this document for free, or read online. Document in PDF available to download.

* Corresponding author 1 MTCT-Plus Programme 2 ISPED - Institut de Santé Publique, d-Epidémiologie et de Développement 3 Epidémiologie, santé publique et développement 4 Ditrame Plus Project, PACCI Collaboration 5 CeDreS - Centre de recherche et de Diagnostic sur le Sida 6 MTCT-Plus Initiative

Abstract : BACKGROUND: Highly active antiretroviral treatment HAART has only been recently recommended for HIV-infected pregnant women requiring treatment for their own health in resource-limited settings. However, there are few documented experiences from African countries. We evaluated the short-term 4 wk and long-term 12 mo effectiveness of a two-tiered strategy of prevention of mother-to-child transmission of HIV PMTCT in Africa: women meeting the eligibility criteria of the World Health Organization WHO received HAART, and women with less advanced HIV disease received short-course antiretroviral scARV PMTCT regimens. METHODS AND FINDINGS: The MTCT-Plus Initiative is a multi-country, family-centred HIV care and treatment program for pregnant and postpartum women and their families. Pregnant women enrolled in Abidjan, C?d-Ivoire received either HAART for their own health or short-course antiretroviral scARV PMTCT regimens according to their clinical and immunological status. Plasma HIV-RNA viral load VL was measured to diagnose peripartum infection when infants were 4 wk of age, and HIV final status was documented either by rapid antibody testing when infants were aged > or = 12 mo or by plasma VL earlier. The Kaplan-Meier method was used to estimate the rate of HIV transmission and HIV-free survival. Between August 2003 and June 2005, 107 women began HAART at a median of 30 wk of gestation, 102 of them with zidovudine ZDV, lamivudine 3TC, and nevirapine NVP and they continued treatment postpartum; 143 other women received scARV for PMTCT, 103 of them with scZDV+3TC with single-dose NVP during labour. Most 75% of the infants were breast-fed for a median of 5 mo. Overall, the rate of peripartum HIV transmission was 2.2% 95% confidence interval CI 0.3%-4.2% and the cumulative rate at 12 mo was 5.7% 95% CI 2.5%-9.0%. The overall probability of infant death or infection with HIV was 4.3% 95% CI 1.7%-7.0% at age week 4 wk and 11.7% 95% CI 7.5%-15.9% at 12 mo. CONCLUSIONS: This two-tiered strategy appears to be safe and highly effective for short- and long-term PMTCT in resource-constrained settings. These results indicate a further benefit of access to HAART for pregnant women who need treatment for their own health.

Author: Besigin Tonwe-Gold - Didier Ekouevi - Ida Viho - Clarisse Amani-Bosse - Siaka Toure - Patrick Coffie - François Rouet - Renaud B



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