title: The impact of maternal highly active antiretroviral therapy and short-course combination antiretrovirals for prevention of mother-to-child transmission on early infant infection rates at the Mulago national referral hospital in Kampala, Uganda, January 2007 to May 2009.
abstract: BACKGROUND
  Early HIV infant diagnosis and treatment have been shown to dramatically improve survival in infants. Despite these findings, infants accessing HIV diagnosis and treatment remain low in Uganda. We describe the antiretroviral (ARV) drugs given in the Mulago Hospital prevention of mother-to-child transmission (PMTCT) program from January 2007 to May 2009 and its impact on early infant HIV infection rates.
  
  
  METHODS
  Pregnant women identified as HIV infected in the Mulago antenatal clinics received one of the following regimens: short-course ARV prophylaxis plus single-dose nevirapine (sdNVP) in labor, highly active antiretroviral therapy (HAART), or sdNVP if they presented in labor. Infants received sdNVP and zidovudine (ZDV) for 1 week. Infants HIV diagnosis was done from 6 weeks after delivery.
  
  
  RESULTS
  62.3% of HIV-infected women received combination ARVs, including HAART. Early infection rates were highest among infants with no maternal ARV [36.4; 95% confidence interval (CI): 17.2 to 59.3] or only sdNVP (11.2; 95% CI: 8.1 to 14.8). Similar rates were observed for the group that took short-course ARVs, ZDV/sdNVP (4.6; 95% CI: 3.2 to 6.4), and ZDV/lamivudine/sdNVP (4.9; 95% CI: 3.1 to 7.2) and lowest rates for those that took HAART (1.7: 95% CI: 0.8 to 2.8). Overall infection rate was 5.0% (95% CI: 4.1 to 5.9).
  
  
  CONCLUSIONS
  Findings indicate low rates of infant infection for mothers receiving combination ARVs. These findings demonstrate that provision of combination ARV for PMTCT is feasible and effective in busy referral hospital's PMTCT programs in resource-limited settings.
authors.affiliation: Makerere University Johns Hopkins Research Collaboration, Mulago Hospital, Uganda. znamukwaya@mujhu.org
authors.forename: Zikulah
authors.initials: Z
authors.lastname: Namukwaya
authors.forename: Peter
authors.initials: P
authors.lastname: Mudiope
authors.forename: Adeodata
authors.initials: A
authors.lastname: Kekitiinwa
authors.forename: Philippa
authors.initials: P
authors.lastname: Musoke
authors.forename: Joyce
authors.initials: J
authors.lastname: Matovu
authors.forename: Sarah
authors.initials: S
authors.lastname: Kayma
authors.forename: William
authors.initials: W
authors.lastname: Salmond
authors.forename: Edward
authors.initials: E
authors.lastname: Bitarakwate
authors.forename: Michael
authors.initials: M
authors.lastname: Mubiru
authors.forename: Albert
authors.initials: A
authors.lastname: Maganda
authors.forename: Moses
authors.initials: M
authors.lastname: Galla
authors.forename: Josaphat
authors.initials: J
authors.lastname: Byamugisha
authors.forename: Mary Glenn
authors.initials: MG
authors.lastname: Fowler
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control* / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D019829:Nevirapine / Q000008:administration & dosage / Q000627:therapeutic use; D016017:Odds Ratio; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D012189:Retrospective Studies; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult; D015215:Zidovudine / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D015215:Zidovudine; D019829:Nevirapine