title: Increased infant human immunodeficiency virus-type one free survival at one year of age in sub-saharan Africa with maternal use of highly active antiretroviral therapy during breast-feeding.
abstract: BACKGROUND
  Reduction of HIV-1 breast-feeding transmission remains a challenge for prevention of pediatric infections in Sub-Saharan Africa. Provision of formula decreases transmission but often increases child mortality in this setting.
  
  
  METHODS
  A prospective observational cohort study of HIV-1 exposed infants of mothers receiving pre and postnatal medical care at Drug Resource Enhancement Against AIDS and Malnutrition centers in Mozambique was conducted. Live-born infants of HIV-1-infected women receiving medical care were enrolled. HIV-1 testing was performed at 1, 6, and 12 months of age using branched DNA. Mothers were counseled to breast-feed exclusively for 6 months and were provided HAART antenatally and postnatally for the first 6 months. Women with CD4 cell counts less than 350/cmm at baseline continued HAART indefinitely.
  
  
  RESULTS
  Of 341 infants followed from birth, 313 mother-infant pairs (92%) completed 6 months and 283 (83%) completed 12 months of follow-up. HIV-1 diagnosis was ascertained in 287 infants (84%) including 4 who died. There were 8 cases of HIV-1 transmission: 4 of 341 (1.2%) at 1 month, 2 of 313 (0.6%) at 6 months, and 2 of 276 (0.7%) at 12 months (cumulative rate: 2.8%). Two mothers (0.6%) and 11 infants (3.2%) died. Maternal and infant mortality rates were 587 of 100,000 and 33 of 1000, while country rates are 1000 of 100,000 and 101 of 1000. HIV risk reduction was 93% and HIV-free survival at 12 months was 94%.
  
  
  CONCLUSIONS
  Late postnatal transmission of HIV-1 is significantly decreased by maternal use of HAART with high infant survival rates up to 12 months of age.
authors.affiliation: Department of Public Health, LUMSA University, Rome, Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Marazzi
authors.forename: Karin
authors.initials: K
authors.lastname: Nielsen-Saines
authors.forename: Ersilia
authors.initials: E
authors.lastname: Buonomo
authors.forename: Paola
authors.initials: P
authors.lastname: Scarcella
authors.forename: Paola
authors.initials: P
authors.lastname: Germano
authors.forename: Nuria Abdul
authors.initials: NA
authors.lastname: Majid
authors.forename: Ines
authors.initials: I
authors.lastname: Zimba
authors.forename: Susanna
authors.initials: S
authors.lastname: Ceffa
authors.forename: Leonardo
authors.initials: L
authors.lastname: Palombi
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara; D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001942:Breast Feeding; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission*; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D053208:Kaplan-Meier Estimate; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D016016:Proportional Hazards Models; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents