Improving outcomes in infants of HIV-infected women in a developing country setting.
BACKGROUND
Since 1999 GHESKIO, a large voluntary counseling and HIV testing center in Port-au-Prince, Haiti, has had an ongoing collaboration with the Haitian Ministry of Health to reduce the rate of mother to child HIV transmission. There are limited data on the ability to administer complex regimens for reducing mother to child transmission and on risk factors for continued transmission and infant mortality within programmatic settings in developing countries.


RESULTS
We analyzed data from 551 infants born to HIV-infected mothers seen at GHESKIO, between 1999 and 2005. HIV-infected mothers and their infants were given "short-course" monotherapy with antiretrovirals for prophylaxis; and, since 2003, highly active antiretroviral therapy (HAART) when clinical or laboratory indications were met. Infected women seen in the pre-treatment era had 27% transmission rates, falling to 10% in this cohort of 551 infants, and to only 1.9% in infants of women on HAART. Mortality rate after HAART introduction (0.12 per year of follow-up [0.08-0.16]) was significantly lower than the period before the availability of such therapy (0.23 [0.16-0.30], P<0.0001). The effects of maternal health, infant feeding, completeness of prophylaxis, and birth weight on mortality and transmission were determined using univariate and multivariate analysis. Infant HIV-1 infection and low birth weight were associated with infant mortality in less than 15 month olds in multivariate analysis.


CONCLUSIONS
Our findings demonstrate success in prevention of mother-to-child HIV transmission and mortality in a highly resource constrained setting. Elements contributing to programmatic success include provision of HAART in the context of a comprehensive program with pre and postnatal care for both mother and infant.
Noel
Francine
F
Les Centres GHESKIO, Port-au-Prince, Haiti.
Mehta
Sapna
S
Zhu
Yuwei
Y
Rouzier
Patricia De Matteis
Pde M
Marcelin
Abdias
A
Shi
Jian R
JR
Nolte
Claudine
C
Severe
Linda
L
Deschamps
Marie Marcelle
MM
Fitzgerald
Daniel W
DW
Johnson
Warren D
WD
Wright
Peter F
PF
Pape
Jean W
JW
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control / Q000635:transmission*; D015497:HIV-1 / Q000502:physiology; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000401:mortality / Q000517:prevention & control; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D012307:Risk Factors; D016896:Treatment Outcome