title: Effectiveness of multidrug antiretroviral regimens to prevent mother-to-child transmission of HIV-1 in routine public health services in Cameroon.
abstract: BACKGROUND
  Multidrug antiretroviral (ARV) regimens including HAART and short-course dual antiretroviral (sc-dARV) regimens were introduced in 2004 to improve Prevention of Mother-to-Child Transmission (PMTCT) in Cameroon. We assessed the effectiveness of these regimens from 6-10 weeks and 12 months of age, respectively.
  
  
  RESULTS
  We conducted a retrospective cohort study covering the period from October 2004 to March 2008 in a reference hospital in Cameroon. HIV-positive pregnant women with CD4 < or = 350 cells/mm(3) received first-line HAART [regimen 1] while the others received ARV prophylaxis including sc-dARV or single dose nevirapine (sd-NVP). Sc-dARV included at least two drugs according to different gestational ages: zidovudine (ZDV) from 28-32 weeks plus sd-NVP [regimen 2], ZDV and lamuvidine (3TC) from 33-36 weeks plus sd-NVP [regimen 3]. When gestational age was > or = 37 weeks, women received sd-NVP during labour [regimen 4]. Infants received sd-NVP plus ZDV and 3TC for 7 days or 30 days. Early diagnosis (6-10 weeks) was done, using b-DNA and subsequently RT-PCR. We determined early MTCT rate and associated risk factors using logistic regression. The 12-month HIV-free survival was assessed using Cox regression. Among 418 mothers, 335 (80%) received multidrug ARV regimens (1, 2, and 3) and MTCT rate with multidrug regimens was 6.6% [95%CI: 4.3-9.6] at 6 weeks, without any significant difference between regimens. Duration of mother's ARV regimen < 4 weeks [OR = 4.7, 95%CI: 1.3-17.6], mother's CD4 < 350 cells/mm(3) [OR = 6.4, 95%CI: 1.8-22.5] and low birth weight [OR = 4.0, 95%CI: 1.4-11.3] were associated with early MTCT. By 12 months, mixed feeding [HR = 8.7, 95%CI: 3.6-20.6], prematurity [HR = 2.3, 95%CI: 1.2-4.3] and low birth weight were associated with children's risk of progressing to infection or death.
  
  
  CONCLUSIONS
  Multidrug ARV regimens for PMTCT are feasible and effective in routine reference hospital. Early initiation of ARV during pregnancy and proper obstetrical care are essential to improve PMTCT.
authors.affiliation: Laboratoire Epidémiologie, Centre Pasteur du Cameroun, Yaoundé, Cameroon. Tchendjou@pasteur-yaounde.org
authors.forename: Patrice
authors.initials: P
authors.lastname: Tchendjou
authors.forename: Chantal
authors.initials: C
authors.lastname: Same-Ekobo
authors.forename: Annie
authors.initials: A
authors.lastname: Nga
authors.forename: Mathurin
authors.initials: M
authors.lastname: Tejiokem
authors.forename: Anfumbom
authors.initials: A
authors.lastname: Kfutwah
authors.forename: Anne Njom
authors.initials: AN
authors.lastname: Nlend
authors.forename: Landry
authors.initials: L
authors.lastname: Tsague
authors.forename: Anne Cécile
authors.initials: AC
authors.lastname: Bissek
authors.forename: Daniel
authors.initials: D
authors.lastname: Ekoa
authors.forename: Joanna
authors.initials: J
authors.lastname: Orne-Gliemann
authors.forename: Dominique
authors.initials: D
authors.lastname: Rousset
authors.forename: Régis
authors.initials: R
authors.lastname: Pouillot
authors.forename: François
authors.initials: F
authors.lastname: Dabis
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D002163:Cameroon; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission; D015497:HIV-1; D006296:Health Services; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents
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