Antiretroviral treatment and prevention of peripartum and postnatal HIV transmission in West Africa : evaluation of two-tiered approach

• Published in: PLoS medicine Vol. 4; no. 8; pp. 1362 - 1373
• Main Authors: TONWE-GOLD, B, EKOUEVI, D.K, ABRAMS, E.J, DABIS, F, VIHO, I, AMANI-BOSSE, C, TOURE, S, COFFIE, P.A, ROUET, F, BECQUET, R, LEROY, V, EL-SADR, W
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.08.2007; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; AIDS; Anti-HIV Agents - administration & dosage; Anti-HIV Agents - adverse effects; Anti-HIV Agents - therapeutic use; Antiretroviral Therapy, Highly Active - adverse effects; Antiretroviral Therapy, Highly Active - utilization; Antiviral agents; Biological and medical sciences; Breast Feeding - adverse effects; CD4 Lymphocyte Count; Cohort Studies; Cote d'Ivoire - epidemiology; Disease transmission; Dosage and administration; Drug therapy; Female; Follow-Up Studies; Health aspects; HIV; HIV infection; HIV infection in children; HIV Infection/AIDS; HIV Infections - congenital; HIV Infections - drug therapy; HIV Infections - prevention & control; HIV Infections - transmission; HIV-1; Human immunodeficiency virus; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Infants; Infectious Disease Transmission, Vertical - prevention & control; Infectious Diseases; Lamivudine - administration & dosage; Lamivudine - therapeutic use; Life Sciences; Male; Medical sciences; Medicine in Developing Countries; Methods; Miscellaneous; Nevirapine - administration & dosage; Nevirapine - therapeutic use; Pregnancy; Pregnancy Complications, Infectious - drug therapy; Pregnant women; Prevention; Prevention and actions; Program Evaluation; Public Health and Epidemiology; Public health. Hygiene; Public health. Hygiene-occupational medicine; Puerperal Disorders - drug therapy; Santé publique et épidémiologie; Viral Load; Womens health; Zidovudine - administration & dosage; Zidovudine - therapeutic use; Côte d'Ivoire; Africa; Cote d'Ivoire; West Africa; Human; Prevalence; Retroviridae; Infant; AIDS; Lentivirus; Infection; Virus; Prevention; Chemotherapy; Treatment; Viral disease; Antiviral; Human immunodeficiency virus; HIV Infections; HIV-1; Infant, Low Birth Weight; Puerperal Disorders; Follow-Up Studies; Nevirapine; Humans; Breast Feeding; Cote d'Ivoire; Lamivudine; Male; CD4 Lymphocyte Count; Pregnancy Complications, Infectious; Anti-HIV Agents; Infectious Disease Transmission, Vertical; Viral Load; Antiretroviral Therapy, Highly Active; Pregnancy; Female; Program Evaluation; Zidovudine; Infant, Newborn; Cohort Studies
• ISSN: 1549-1277; 1549-1676; 1549-1676
• DOI: 10.1371/journal.pmed.0040257

Highly active antiretroviral treatment (HAART) has only been recently recommended for HIV-infected pregnant women requiring treatment for their own health in resource-limited settings. However, there are few documented experiences from African countries. We evaluated the short-term (4 wk) and long-term (12 mo) effectiveness of a two-tiered strategy of prevention of mother-to-child transmission of HIV (PMTCT) in Africa: women meeting the eligibility criteria of the World Health Organization (WHO) received HAART, and women with less advanced HIV disease received short-course antiretroviral (scARV) PMTCT regimens. The MTCT-Plus Initiative is a multi-country, family-centred HIV care and treatment program for pregnant and postpartum women and their families. Pregnant women enrolled in Abidjan, Côte d'Ivoire received either HAART for their own health or short-course antiretroviral (scARV) PMTCT regimens according to their clinical and immunological status. Plasma HIV-RNA viral load (VL) was measured to diagnose peripartum infection when infants were 4 wk of age, and HIV final status was documented either by rapid antibody testing when infants were aged > or = 12 mo or by plasma VL earlier. The Kaplan-Meier method was used to estimate the rate of HIV transmission and HIV-free survival. Between August 2003 and June 2005, 107 women began HAART at a median of 30 wk of gestation, 102 of them with zidovudine (ZDV), lamivudine (3TC), and nevirapine (NVP) and they continued treatment postpartum; 143 other women received scARV for PMTCT, 103 of them with sc(ZDV+3TC) with single-dose NVP during labour. Most (75%) of the infants were breast-fed for a median of 5 mo. Overall, the rate of peripartum HIV transmission was 2.2% (95% confidence interval [CI] 0.3%-4.2%) and the cumulative rate at 12 mo was 5.7% (95% CI 2.5%-9.0%). The overall probability of infant death or infection with HIV was 4.3% (95% CI 1.7%-7.0%) at age week 4 wk and 11.7% (95% CI 7.5%-15.9%) at 12 mo. This two-tiered strategy appears to be safe and highly effective for short- and long-term PMTCT in resource-constrained settings. These results indicate a further benefit of access to HAART for pregnant women who need treatment for their own health.