title: WHO 2010 guidelines for prevention of mother-to-child HIV transmission in Zimbabwe: modeling clinical outcomes in infants and mothers.
abstract: BACKGROUND
  The Zimbabwean national prevention of mother-to-child HIV transmission (PMTCT) program provided primarily single-dose nevirapine (sdNVP) from 2002-2009 and is currently replacing sdNVP with more effective antiretroviral (ARV) regimens.
  
  
  METHODS
  Published HIV and PMTCT models, with local trial and programmatic data, were used to simulate a cohort of HIV-infected, pregnant/breastfeeding women in Zimbabwe (mean age 24.0 years, mean CD4 451 cells/µL). We compared five PMTCT regimens at a fixed level of PMTCT medication uptake: 1) no antenatal ARVs (comparator); 2) sdNVP; 3) WHO 2010 guidelines using "Option A" (zidovudine during pregnancy/infant NVP during breastfeeding for women without advanced HIV disease; lifelong 3-drug antiretroviral therapy (ART) for women with advanced disease); 4) WHO "Option B" (ART during pregnancy/breastfeeding without advanced disease; lifelong ART with advanced disease); and 5) "Option B+:" lifelong ART for all pregnant/breastfeeding, HIV-infected women. Pediatric (4-6 week and 18-month infection risk, 2-year survival) and maternal (2- and 5-year survival, life expectancy from delivery) outcomes were projected.
  
  
  RESULTS
  Eighteen-month pediatric infection risks ranged from 25.8% (no antenatal ARVs) to 10.9% (Options B/B+). Although maternal short-term outcomes (2- and 5-year survival) varied only slightly by regimen, maternal life expectancy was reduced after receipt of sdNVP (13.8 years) or Option B (13.9 years) compared to no antenatal ARVs (14.0 years), Option A (14.0 years), or Option B+ (14.5 years).
  
  
  CONCLUSIONS
  Replacement of sdNVP with currently recommended regimens for PMTCT (WHO Options A, B, or B+) is necessary to reduce infant HIV infection risk in Zimbabwe. The planned transition to Option A may also improve both pediatric and maternal outcomes.
authors.affiliation: Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America. aciaranello@partners.org
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Ciaranello
authors.forename: Freddy
authors.initials: F
authors.lastname: Perez
authors.forename: Matthews
authors.initials: M
authors.lastname: Maruva
authors.forename: Jennifer
authors.initials: J
authors.lastname: Chu
authors.forename: Barbara
authors.initials: B
authors.lastname: Engelsmann
authors.forename: Jo
authors.initials: J
authors.lastname: Keatinge
authors.forename: Rochelle P
authors.initials: RP
authors.lastname: Walensky
authors.forename: Angela
authors.initials: A
authors.lastname: Mushavi
authors.forename: Rumbidzai
authors.initials: R
authors.lastname: Mugwagwa
authors.forename: Francois
authors.initials: F
authors.lastname: Dabis
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D001942:Breast Feeding; D002648:Child; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D009313:National Health Programs / Q000639:trends; D019829:Nevirapine / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D016019:Survival Analysis; D014944:World Health Organization; D055815:Young Adult; D015215:Zidovudine / Q000627:therapeutic use; D015030:Zimbabwe
chemical_list: D019380:Anti-HIV Agents; D015215:Zidovudine; D019829:Nevirapine