#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Comparison of 6-week PMTCT outcomes for HIV-exposed and HIV-unexposed infants in the era of lifelong ART: Results from an observational prospective cohort study


Autoři: Appolinaire Tiam aff001;  Seble G. Kassaye aff003;  Rhoderick Machekano aff001;  Vincent Tukei aff004;  Michelle M. Gill aff001;  Majoalane Mokone aff004;  Mosilinyane Letsie aff005;  Mots’oane Tsietso aff005;  Irene Seipati aff005;  Janety Barasa aff004;  Anthony Isavwa aff004;  Thorkild Tylleskär aff002;  Laura Guay aff001
Působiště autorů: Elizabeth Glaser Pediatric AIDS Foundation, Washington D.C., United States of America aff001;  Centre for International Health, University of Bergen, Bergen, Norway aff002;  Department of Medicine Georgetown University School of Medicine, Washington D.C., United States of America aff003;  Elizabeth Glaser Pediatric AIDS Foundation, Maseru, Lesotho aff004;  Ministry of Health, Maseru, Lesotho aff005;  Department of Epidemiology and Biostatistics, George Washington University Milken Institute School of Public Health, Washington D.C., United States of America aff006
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0226339

Souhrn

Background

Lifelong antiretroviral therapy (ART) reduces mother-to-child HIV transmission (MTCT) and improves maternal health. Data on the outcomes of HIV-exposed infants (HEI) compared to their unexposed counterparts in the era of universal ART is limited. We compared birth and 6-week outcomes among infants born to HIV-positive and HIV-negative women in Lesotho.

Methods

941 HIV-negative and 653 HIV-positive pregnant women were enrolled in an observational cohort to evaluate the effectiveness of prevention of mother-to-child HIV transmission (PMTCT) program after implementation of universal maternal ART in 14 health facilities. Pregnancy, delivery, birth, and 6-week data were collected through participant interviews and medical record review. DNA PCR testing for HEI was conducted within 2 weeks of birth and at around 6 weeks of age. Data were analysed to estimate the distribution of birth outcomes, mortality, HIV transmission and HIV-free survival at 6 weeks.

Results

HIV-positive women were older (mean age of 28.7 vs. 24.4 years) and presented for antenatal care earlier (mean gestational age of 23.0 weeks vs 25.3 weeks) than HIV-negative women. Prematurity was more frequent among HEI, 7.8% vs. 3.6%. There was no difference in rates of congenital anomalies between HEI (1.0%) and HIV-unexposed infants (HUI) (0.6%). Cumulative HIV transmission was 0.9% (N = 4/431) (95% CI:0.25–2.36) at birth and 1.0% (N = 6/583) (95% CI:0.38–2.23) at 6 weeks. Overall mortality, including stillbirths, was 5.2% and 6.0% by 6 weeks for HUI and HEI respectively. Among liveborn infants, 6-week HIV-free survival for HEI was 95.6% (95% CI:93.7–97.1) compared to 96.8% (95% CI:95.4–97.9) survival for HUI.

Conclusions

Implementation of universal maternal ART lowers MTCT at 6 weeks of age with no differences in congenital anomalies or early mortality between HIV exposed Infants and HIV unexposed infants. However, HIV exposed infants continue to have high rates of prematurity despite improved maternal health on ART.

Klíčová slova:

Antenatal care – Assisted reproductive technology – Infants – Labor and delivery – Pregnancy – Stillbirths


Zdroje

1. The Kingdom Of Lesotho, Government of Lesotho. Final Report for a Joint Review of HIV/Tuberculosis and Hepatitis Programmes. 2 December, 2017. Available from: http://www.unaids.org/sites/default/files/country/documents/LSO_2018_countryreport.pdf. Cited 2 January 2019.

2. Kesho Bora Study Group. Triple antiretroviral compared with zidovudine and single-dose nevirapine prophylaxis during pregnancy and breastfeeding for prevention of mother-to-child transmission of HIV-1 (Kesho Bora study): a randomised controlled trial. Lancet Infect Dis. 2011;11(3): 171–80. doi: 10.1016/S1473-3099(10)70288-7 21237718

3. Li N, Sando MM, Spiegelman D, Hertzmark E, Liu E, Sando D, et al. Antiretroviral therapy in relation to birth outcomes among HIV-infected women: A cohort study. J Infect Dis. 2016;213(7): 1057–64. doi: 10.1093/infdis/jiv389 26265780

4. Chen JY, Ribaudo HJ, Souda S, Parekh N, Ogwu A, Lockman S et al. Highly active antiretroviral therapy and adverse birth outcomes among HIV-infected women in Botswana. J Infect Dis. 2012;206(11): 1695–1705. doi: 10.1093/infdis/jis553 23066160

5. Watts DH, Mofenson LM. Antiretrovirals in pregnancy: a note of caution. J Infect Dis. 2012;206(11): 1639–1641. doi: 10.1093/infdis/jis581 23066163

6. Malaba TR, Phillips T, Le Roux S, Brittain K, Zerbe A, Petro G, et al. Antiretroviral therapy use during pregnancy and adverse birth outcomes in South African women. Int J Epidemiol. 2017 Oct 1;46(5): 1678–1689. doi: 10.1093/ije/dyx136 29040569

7. Alemu FM, Yalew AW, Fantahun M, Ashu EE. Antiretroviral therapy and pregnancy outcomes in developing countries: A systematic review. Int J MCH AIDS. 2015; 3(1): 31–43. 27621984

8. Uthman OA, Nachega JB, Anderson J, Kanters S, Mills EJ, Renaud F, et al. Timing of initiation of antiretroviral therapy and adverse pregnancy outcomes: a systematic review and meta-analysis. Lancet HIV. 2017 Jan;4(1): e21–e30. doi: 10.1016/S2352-3018(16)30195-3 27864000

9. Rempis EM, Schnack A, Decker S, Braun V, Rubaihayo J, Tumwesigye NM, et al. Option B+ for prevention of vertical HIV transmission has no influence on adverse birth outcomes in a cross-sectional cohort in Western Uganda. BMC Pregnancy Childbirth. 2017 Mar 7;17(1): 82. doi: 10.1186/s12884-017-1263-2 28270119

10. Locks LM, Manji KP, Kupka R, Liu E, Kisenge R, McDonald et al. High burden of morbidity and mortality but not growth failure in infants exposed to but uninfected with human immunodeficiency virus in Tanzania. J Pediatr. 2017 Jan;180:191–199.e2. doi: 10.1016/j.jpeds.2016.09.040 27829511

11. Gill MM., Hoffman HJ., Ndatimana D, Mugwaneza P, Guay L, Ndayisaba G F, et al. 24-month HIV-free survival among infants born to HIV-positive women enrolled in Option B+ program in Kigali, Rwanda: The Kabeho Study. Medicine (Baltimore). 2017 Dec;96(51): e9445.

12. Ministry of Health, Government of Lesotho. National guidelines for the prevention of mother to child transmission of HIV. Maseru, Lesotho: Ministry of Health; 2013.

13. Ministry of Health, Government of Lesotho. National guidelines on the use of antiretroviral therapy for HIV prevention and treatment, fifth edition. Maseru, Lesotho: Ministry of Health; 2016.

14. Machekano R, Tiam A, Kassaye S, Tukei V, Gill M, Mohai F, et al. HIV incidence among pregnant and postpartum women in a high prevalence setting. PLOS ONE. 2018;13(12): e0209782. doi: 10.1371/journal.pone.0209782 30592749

15. World Health Organisation (WHO). recommendations on interventions to improve preterm birth outcomes. Geneva, 2015. Available: https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/preterm-birth-guideline/en/ Cited 24 September, 2019.

16. Tavares Da Silva F, Gonik B, McMillan M, Keech C, Dellicour S, Bhange S, et al. Stillbirth: Case definition and guidelines for data collection, analysis, and presentation of maternal immunization safety data. Vaccine. 2016;34(49):6057–6068. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139804/pdf/main.pdf Cited 24 September 2019. doi: 10.1016/j.vaccine.2016.03.044 27431422

17. Sebitloane HM, Moodley J. Maternal and obstetric complications among hiv-infected women treated with highly active antiretroviral treatment at a regional hospital in Durban, South Africa. J Clin Pract. 2017;20(11): 1360–1367.

18. Chetty T, Thorne C, Coutsoudis A. Preterm delivery and small-for-gestation outcomes in HIV-infected pregnant women on antiretroviral therapy in rural South Africa: Results from a cohort study, 2010–2015. PLOS ONE. 2018;13(2):e0192805. doi: 10.1371/journal.pone.0192805 29470508

19. Dadabhai S, Gadama L, Chamanga R, Kawalazira R, Katumbi C, Makanani B, et al. Pregnancy outcomes in the era of universal antiretroviral treatment in sub-Saharan Africa (POISE Study). J Acquir Immune Defic Syndr. 2019 Jan 1;80(1): 7–14. doi: 10.1097/QAI.0000000000001875 30272628

20. Tiam M, Velaphi S. Maternal human immunodeficiency virus status and morbidity and mortality in very low birthweight infants. Paediatr Int Child Health. 2017 Feb;37(1): 14–20. doi: 10.1179/2046905515Y.0000000060 26403835

21. Nachega JB, Uthman OA, Mofenson LM, Anderson JR, Kanters S, Renaud F, et al. Safety of tenofovir disoproxil fumarate-based antiretroviral therapy regimens in pregnancy for HIV-positive women and their infants: A systematic review and meta-analysis. J Acquir Immune Defic Syndr. 2017 Sep 1;76(1): 1–12. doi: 10.1097/QAI.0000000000001359 28291053

22. Kalk E, Schubert P, Bettinger JA, Cotton MF, Esser M, Slogrove A, et al. Placental pathology in HIV infection at term: a comparison with HIV-uninfected women. Trop Med Int Health. 2017 May;22(5): 604–613. doi: 10.1111/tmi.12858 28214384

23. Shapiro RL, Souda S, Parekh N, Binda K, Kayembe M, Lockman S, et al. High prevalence of hypertension and placental insufficiency, but no in utero HIV transmission, among women on HAART with stillbirths in Botswana. PLOS ONE. 2012;7(2): e31580. doi: 10.1371/journal.pone.0031580 22384039

24. Abuogi LL, Humphrey JM, Mpody C, Yotebieng M, Murnane PM, Clouse K, et al. Achieving UNAIDS 90-90-90 targets for pregnant and postpartum women in sub-Saharan Africa: progress, gaps and research needs. J Virus Erad. 2018;4(Suppl 2): 33–39. 30515312

25. Smith SJ, Nimmo C, Fredlund V, Moodley P. Early infant diagnosis of HIV and fast initiation of anti-retroviral therapy in a rural African setting: how well are we doing? Paediatr Int Child Health. 2014;34(3): 203–7. doi: 10.1179/2046905514Y.0000000119 24655116

26. Satti H, Motsamai S, Chetane P, Marumo L, Barry DJ, Riley J, et al. Comprehensive approach to improving maternal health and achieving MDG 5: Report from the mountains of Lesotho. PLoS ONE. 2012;7(8): e42700. Available from: https://doi.org/10.1371/journal.pone.0042700 Cited 4 May 2019. 22952607

27. Tiam A, Machekano R, Gill M, Letsie M, Tukei V, Motsoane T, et al. Measuring PMTCT program effectiveness among women and infants through community-based household surveys in Lesotho. Report 2017.


Článek vyšel v časopise

PLOS One


2019 Číslo 12
Nejčtenější tento týden
Nejčtenější v tomto čísle
Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

KOST
Koncepce osteologické péče pro gynekology a praktické lékaře
nový kurz
Autoři: MUDr. František Šenk

Sekvenční léčba schizofrenie
Autoři: MUDr. Jana Hořínková

Hypertenze a hypercholesterolémie – synergický efekt léčby
Autoři: prof. MUDr. Hana Rosolová, DrSc.

Svět praktické medicíny 5/2023 (znalostní test z časopisu)

Imunopatologie? … a co my s tím???
Autoři: doc. MUDr. Helena Lahoda Brodská, Ph.D.

Všechny kurzy
Kurzy Podcasty Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Zadejte e-mailovou adresu, se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se

#ADS_BOTTOM_SCRIPTS#