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Pediatr Infect Dis J. 2018 Nov;37(11):1137-1141. doi: 10.1097/INF.0000000000001997.

Infant Human Immunodeficiency Virus-free Survival in the Era of Universal Antiretroviral Therapy for Pregnant and Breastfeeding Women: A Community-based Cohort Study From Rural Zambia.

Author information

1
From the School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
2
School of Public Health, University of Zambia, Lusaka, Zambia.
3
Zambian Ministry of Health, Lusaka, Zambia.
4
Zambart, Lusaka, Zambia.
5
London School of Hygiene and Tropical Medicine, London, United Kingdom.

Abstract

BACKGROUND:

Lifelong antiretroviral therapy (ART) is now recommended for all human immunodeficiency virus (HIV)-infected pregnant and breastfeeding women; however, few have described overall infant outcomes in this new era for the prevention of mother-to-child HIV transmission (PMTCT).

METHODS:

As part of an assessment of PMTCT program impact, we enrolled a prospective cohort study in 4 predominantly rural districts in Zambia. HIV-infected mothers and their newborns (≤30 days old) were recruited and followed at 6 weeks, 6 months and 12 months postpartum; infant specimens were tested via HIV DNA polymerase chain reaction. In Kaplan-Meier analyses, we estimated overall infant HIV-free survival and then stratified by district, community and maternal ART use. We investigated the relationship between community-level 12-month, self-reported maternal ART use and infant HIV-free survival via linear regression.

RESULTS:

From June 2014 to November 2015, we enrolled 827 mother-infant pairs in 33 communities. At 12 months, small proportions of infants had died (2.8%), were HIV-infected (3.0%) or were lost to follow-up (4.3%). Overall, infant HIV-free survival was 99.0% [95% confidence interval (CI): 98.0%-99.5%] at 6 weeks, 97.5% (95% CI: 96.1%-98.4%) at 6 months and 96.3% (95% CI: 94.8%-97.4%) at 12 months. Women reporting ART use at enrollment had higher infant HIV-free survival than those who did not (97.4% vs. 89.0%, P = 0.01). Differences were noted at the district and site levels (P = 0.01). In community-level analysis, no relationship was observed between 12-month infant HIV-free survival and self-reported maternal ART use (P = 0.65).

CONCLUSION:

Although encouraging, these findings highlight the need for rigorous monitoring and evaluation of PMTCT services at the population level.

PMID:
29601456
PMCID:
PMC6160366
[Available on 2019-11-01]
DOI:
10.1097/INF.0000000000001997
[Indexed for MEDLINE]

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