title: Mother-to-Child Transmission Outcomes of HIV-Exposed Infants Followed Up in Jos North-Central Nigeria.
abstract: OBJECTIVE
  Since 2010, Nigeria has adopted World Health Organization (WHO) 'Option B' which requires administration of triple antiretroviral prophylaxis or treatment (ART) to all HIVinfected pregnant women. We studied the transmission outcomes of HIV-exposed children up to 18 months of age.
  
  
  METHODS
  This was a retrospective, observational study of HIV-infected pregnant women and their exposed infants who accessed prevention of mother to child transmission (PMTCT) services at Jos University Teaching Hospital, Jos, North-central Nigeria.
  
  
  METHODS
  HIV-infected women were enrolled during antenatal care or at labor/delivery between January 1, 2010 and December 31, 2012. Antiretroviral (ARV) prophylaxis/therapy was provided according to the 2010 Nigerian PMTCT guidelines (adapted WHO 2010 guidelines); Infant HIV diagnosis was performed at 6 weeks and at 6 months. HIV antibody diagnosis was used for exposed children at 18 months.
  
  
  RESULTS
  A total of 996 HIV-exposed children were followed up. Of those children, 140 (14.1%) were lost to follow up by 18 months of age. Twelve children (1.4%) died (all HIV negative) before 18 months of age and six infants (0.7%) were confirmed to be HIV-infected (4 by the age of 6 months and 2 thereafter) and were referred for treatment. A total of 838 (84.1%) children tested HIV negative at 18 months and were discharged. Mother-to-child transmission (MTCT) of HIV by 18 months was lower among women on ART before pregnancy compared to those women who started ART/Triple ARV prophylaxis during pregnancy/delivery. (0.4%; 3/700 vs 2.0%; 3/150 P=0.05). Home delivery was associated with higher transmission than facility delivery (p=0.03). Mode of delivery or method of infant feeding had no significant impact on vertical transmission by 18 months.
  
  
  CONCLUSIONS
  In North-central Nigeria where HIV is prevalent, ART started before pregnancy is enormously effective in preventing mother-to-child transmission. Adoption of WHO 'Option B+' deserves serious consideration in such settings.
authors.affiliation: Department of Obstetrics and Gynecology, University of Jos, Jos, Nigeria. atsagay58@yahoo.com.
authors.forename: Atiene S
authors.initials: AS
authors.lastname: Sagay
authors.forename: Augustine O
authors.initials: AO
authors.lastname: Ebonyi
authors.forename: Seema T
authors.initials: ST
authors.lastname: Meloni
authors.forename: Jonah
authors.initials: J
authors.lastname: Musa
authors.forename: Stephen
authors.initials: S
authors.lastname: Oguche
authors.forename: Chinedu C
authors.initials: CC
authors.lastname: Ekwempu
authors.forename: Tinuade
authors.initials: T
authors.lastname: Oyebode
authors.forename: Emeka
authors.initials: E
authors.lastname: Ejeliogu
authors.forename: Godwin E
authors.initials: GE
authors.lastname: Imade
authors.forename: Oche O
authors.initials: OO
authors.lastname: Agbaji
authors.forename: Prosper
authors.initials: P
authors.lastname: Okonkwo
authors.forename: Phyllis J
authors.initials: PJ
authors.lastname: Kanki
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018890:Chemoprevention / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents; D015483:HIV Antibodies