Extended antenatal antiretroviral use correlates with improved infant outcomes throughout the first year of life.
OBJECTIVE
To evaluate the effect of extended antenatal triple antiretroviral therapy (ART) on infant outcomes.


METHODS
Retrospective cohort study using pooled data from health clinics in Malawi and Mozambique from July 2005 to December 2009.


METHODS
Computerized records of 3273 HIV-infected pregnant women accessing Drug Resource Enhancement Against AIDS and Malnutrition centers were reviewed. ART regimens consisted of nevirapine-based HAART as of 14-25 weeks gestation until 6 months postpartum. Infant infection was determined at 1, 6 and 12 months of age by branched DNA.


RESULTS
A total of 3071 pregnancies resulted in 3148 live births. Lost to follow-up, infant deaths and HIV-1 infection rates at 1 and 12 months were 1.3 and 11.5, 0.8 and 6.7 and 0.8 and 2.0, respectively. Infant HIV-1-free survival at 12 months was 92.5%. Mother-to-child transmission and/or infant deaths correlated with length of maternal antenatal ART by multivariate analysis at 1, 6 and 12 months: 14% in women with more than 30 days of triple antenatal ART and 6.9% in mothers receiving at least 90 days of antenatal ART, P = 0.001. Fifty percent of 54 episodes of transmission occurred in women with higher CD4 cell counts (>350 cells/μl). Infant mortality was 67/1000, lower than background rates (78-100/1000). Growth failure (weight-for-age Z score <-2) was present in 8% of infants around birth, 6% at 6 months, 23% at 12 months (lower than country-specific rates).


CONCLUSIONS
Extended antenatal ART is protective against adverse infant outcomes up to 12 months of age even in children born to mothers with higher CD4 cell counts.
Marazzi
Maria C
MC
Division of Infectious Diseases, David Geffen UCLA School of Medicine, Los Angeles, California 90095, USA.
Liotta
Giuseppe
G
Nielsen-Saines
Karin
K
Haswell
Jere
J
Magid
Nurja A
NA
Buonomo
Ersilia
E
Scarcella
Paola
P
Doro Altan
Anna M
AM
Mancinelli
Sandro
S
Palombi
Leonardo
L
D000328:Adult; D001942:Breast Feeding; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000635:transmission; D015497:HIV-1; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D053208:Kaplan-Meier Estimate; D008295:Malawi; D008297:Male; D009073:Mozambique; D019829:Nevirapine / Q000008:administration & dosage*; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome
D019829:Nevirapine