Maternal Highly Active Antiretroviral Therapy and Child HIV-Free Survival in Malawi, 2004–2009

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• 作者：Sheree R. Schwartz ; Newton Kumwenda…
• 关键词：HIV ; 1 ; Prevention of mother ; to ; child transmission ; Highly active antiretroviral therapy ; Child survival ; Breastfeeding
• 刊名：Maternal and Child Health Journal
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：20
• 期：3
• 页码：542-549
• 全文大小：427 KB
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• 作者单位：Sheree R. Schwartz (1)
  Newton Kumwenda (1)
  Johnstone Kumwenda (2)
  Shu Chen (1)
  Lynne M. Mofenson (3)
  Allan W. Taylor (4)
  Mary Glenn Fowler (5)
  Taha E. Taha (1)
  
  1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E7139, Baltimore, MD, 21205, USA
  2. Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
  3. Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA
  4. Epidemiology Branch, Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
  5. Department of Pathology, Johns Hopkins Medical School, Baltimore, MD, USA
  
• 刊物主题：Public Health; Sociology, general; Population Economics; Pediatrics; Gynecology; Maternal and Child Health;
• 出版者：Springer US
• ISSN：1573-6628

文摘

Objectives Highly active antiretroviral therapy (HAART) provision to eligible HIV-infected pregnant and post-partum women is critical for optimizing maternal health. We assessed the impact of maternal HAART on HIV-free survival of breastfed infants in Malawi. Methods The post-exposure prophylaxis of infants-Malawi trial (2004–2009) enrolled mothers/infants during labor or immediately post-partum to evaluate 14-week extended infant antiretroviral prophylaxis for preventing HIV transmission through breastfeeding. Mothers meeting national HAART guidelines were referred for therapy. Child HIV-free survival—survival without HIV infection—was compared by maternal HAART status. Results Overall, 3022 mother-infant pairs contributed 4214 infant/person-years (PY) at-risk for HIV infection or death, with 532 events (incidence 12.6/100 PY, 95 % confidence interval [CI] 11.6–13.7). During follow-up, 349 mothers were HAART initiated; 581 remained HAART naïve with CD4 cell counts <250 cells/mm3, and 2092 were never HAART-eligible. By 3 months, 11 % of infants with HAART naïve mothers (CD4 < 250) were infected with HIV or died versus 7 % of infants of HAART-initiated mothers and 4 % of infants of HAART-ineligible mothers. Maternal HAART was associated with a 46 % reduction in infant HIV infection or death as compared to infants with HAART naïve mothers (CD4 < 250) (adjusted hazards ratio 0.54, 95 % CI 0.36–0.81). Among HIV-exposed, uninfected infants, breastfeeding, but not HAART, was significantly associated with decreased child mortality. Conclusions HIV infection and mortality are high during the first 3 months post-partum in infants of mothers with advanced HIV, and rapid maternal HAART initiation can significantly improve HIV-related infant outcomes. Clinical Trials Registration This study is registered at http://​clinicaltrials.​gov/​ under trial number NCT00115648. Keywords HIV-1 Prevention of mother-to-child transmission Highly active antiretroviral therapy Child survival Breastfeeding