WHO 2010 Guidelines for Prevention of Mother-to-Child HIV Transmission in Zimbabwe: Modeling Clinical Outcomes in Infants and MothersReport as inadecuate




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Background

The Zimbabwean national prevention of mother-to-child HIV transmission PMTCT program provided primarily single-dose nevirapine sdNVP from 2002–2009 and is currently replacing sdNVP with more effective antiretroviral ARV regimens.

Methods

Published HIV and PMTCT models, with local trial and programmatic data, were used to simulate a cohort of HIV-infected, pregnant-breastfeeding women in Zimbabwe mean age 24.0 years, mean CD4 451 cells-µL. We compared five PMTCT regimens at a fixed level of PMTCT medication uptake: 1 no antenatal ARVs comparator; 2 sdNVP; 3 WHO 2010 guidelines using -Option A- zidovudine during pregnancy-infant NVP during breastfeeding for women without advanced HIV disease; lifelong 3-drug antiretroviral therapy ART for women with advanced disease; 4 WHO -Option B- ART during pregnancy-breastfeeding without advanced disease; lifelong ART with advanced disease; and 5 -Option B+:- lifelong ART for all pregnant-breastfeeding, HIV-infected women. Pediatric 4–6 week and 18-month infection risk, 2-year survival and maternal 2- and 5-year survival, life expectancy from delivery outcomes were projected.

Results

Eighteen-month pediatric infection risks ranged from 25.8% no antenatal ARVs to 10.9% Options B-B+. Although maternal short-term outcomes 2- and 5-year survival varied only slightly by regimen, maternal life expectancy was reduced after receipt of sdNVP 13.8 years or Option B 13.9 years compared to no antenatal ARVs 14.0 years, Option A 14.0 years, or Option B+ 14.5 years.

Conclusions

Replacement of sdNVP with currently recommended regimens for PMTCT WHO Options A, B, or B+ is necessary to reduce infant HIV infection risk in Zimbabwe. The planned transition to Option A may also improve both pediatric and maternal outcomes.



Author: Andrea L. Ciaranello , Freddy Perez, Matthews Maruva, Jennifer Chu, Barbara Engelsmann, Jo Keatinge, Rochelle P. Walensky, Angela

Source: http://plos.srce.hr/



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