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: 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

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Článek vyšel v časopise

PLOS One


2019 Číslo 12