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Increased infant human immunodeficiency virus-type one free survival at one year of age in sub-saharan Africa with maternal use of highly active antiretroviral therapy during breast-feeding.
Pediatr Infect Dis J. 2009 Jun; 28(6):483-7.PI

Abstract

BACKGROUND

Reduction of HIV-1 breast-feeding transmission remains a challenge for prevention of pediatric infections in Sub-Saharan Africa. Provision of formula decreases transmission but often increases child mortality in this setting.

METHODS

A prospective observational cohort study of HIV-1 exposed infants of mothers receiving pre and postnatal medical care at Drug Resource Enhancement Against AIDS and Malnutrition centers in Mozambique was conducted. Live-born infants of HIV-1-infected women receiving medical care were enrolled. HIV-1 testing was performed at 1, 6, and 12 months of age using branched DNA. Mothers were counseled to breast-feed exclusively for 6 months and were provided HAART antenatally and postnatally for the first 6 months. Women with CD4 cell counts less than 350/cmm at baseline continued HAART indefinitely.

RESULTS

Of 341 infants followed from birth, 313 mother-infant pairs (92%) completed 6 months and 283 (83%) completed 12 months of follow-up. HIV-1 diagnosis was ascertained in 287 infants (84%) including 4 who died. There were 8 cases of HIV-1 transmission: 4 of 341 (1.2%) at 1 month, 2 of 313 (0.6%) at 6 months, and 2 of 276 (0.7%) at 12 months (cumulative rate: 2.8%). Two mothers (0.6%) and 11 infants (3.2%) died. Maternal and infant mortality rates were 587 of 100,000 and 33 of 1000, while country rates are 1000 of 100,000 and 101 of 1000. HIV risk reduction was 93% and HIV-free survival at 12 months was 94%.

CONCLUSIONS

Late postnatal transmission of HIV-1 is significantly decreased by maternal use of HAART with high infant survival rates up to 12 months of age.

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Authors+Show Affiliations

Marazzi MC
Department of Public Health, LUMSA University, Rome, Italy.
Nielsen-Saines K
No affiliation info available
Buonomo E
No affiliation info available
Scarcella P
No affiliation info available
Germano P
No affiliation info available
Majid NA
No affiliation info available
Zimba I
No affiliation info available
Ceffa S
No affiliation info available
Palombi L
No affiliation info available

MeSH

AdultAfrica South of the SaharaAnti-HIV AgentsAntiretroviral Therapy, Highly ActiveBreast FeedingChi-Square DistributionDisease-Free SurvivalFemaleHIV InfectionsHIV-1HumansInfantInfant, NewbornInfectious Disease Transmission, VerticalKaplan-Meier EstimatePregnancyPregnancy Complications, InfectiousProportional Hazards ModelsViral Load

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19483516

Citation

Marazzi, Maria Cristina, et al. "Increased Infant Human Immunodeficiency Virus-type One Free Survival at One Year of Age in Sub-saharan Africa With Maternal Use of Highly Active Antiretroviral Therapy During Breast-feeding." The Pediatric Infectious Disease Journal, vol. 28, no. 6, 2009, pp. 483-7.
Marazzi MC, Nielsen-Saines K, Buonomo E, et al. Increased infant human immunodeficiency virus-type one free survival at one year of age in sub-saharan Africa with maternal use of highly active antiretroviral therapy during breast-feeding. Pediatr Infect Dis J. 2009;28(6):483-7.
Marazzi, M. C., Nielsen-Saines, K., Buonomo, E., Scarcella, P., Germano, P., Majid, N. A., Zimba, I., Ceffa, S., & Palombi, L. (2009). Increased infant human immunodeficiency virus-type one free survival at one year of age in sub-saharan Africa with maternal use of highly active antiretroviral therapy during breast-feeding. The Pediatric Infectious Disease Journal, 28(6), 483-7. https://doi.org/10.1097/INF.0b013e3181950c56
Marazzi MC, et al. Increased Infant Human Immunodeficiency Virus-type One Free Survival at One Year of Age in Sub-saharan Africa With Maternal Use of Highly Active Antiretroviral Therapy During Breast-feeding. Pediatr Infect Dis J. 2009;28(6):483-7. PubMed PMID: 19483516.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Increased infant human immunodeficiency virus-type one free survival at one year of age in sub-saharan Africa with maternal use of highly active antiretroviral therapy during breast-feeding. AU - Marazzi,Maria Cristina, AU - Nielsen-Saines,Karin, AU - Buonomo,Ersilia, AU - Scarcella,Paola, AU - Germano,Paola, AU - Majid,Nuria Abdul, AU - Zimba,Ines, AU - Ceffa,Susanna, AU - Palombi,Leonardo, PY - 2009/6/2/entrez PY - 2009/6/2/pubmed PY - 2009/9/1/medline SP - 483 EP - 7 JF - The Pediatric infectious disease journal JO - Pediatr Infect Dis J VL - 28 IS - 6 N2 - BACKGROUND: Reduction of HIV-1 breast-feeding transmission remains a challenge for prevention of pediatric infections in Sub-Saharan Africa. Provision of formula decreases transmission but often increases child mortality in this setting. METHODS: A prospective observational cohort study of HIV-1 exposed infants of mothers receiving pre and postnatal medical care at Drug Resource Enhancement Against AIDS and Malnutrition centers in Mozambique was conducted. Live-born infants of HIV-1-infected women receiving medical care were enrolled. HIV-1 testing was performed at 1, 6, and 12 months of age using branched DNA. Mothers were counseled to breast-feed exclusively for 6 months and were provided HAART antenatally and postnatally for the first 6 months. Women with CD4 cell counts less than 350/cmm at baseline continued HAART indefinitely. RESULTS: Of 341 infants followed from birth, 313 mother-infant pairs (92%) completed 6 months and 283 (83%) completed 12 months of follow-up. HIV-1 diagnosis was ascertained in 287 infants (84%) including 4 who died. There were 8 cases of HIV-1 transmission: 4 of 341 (1.2%) at 1 month, 2 of 313 (0.6%) at 6 months, and 2 of 276 (0.7%) at 12 months (cumulative rate: 2.8%). Two mothers (0.6%) and 11 infants (3.2%) died. Maternal and infant mortality rates were 587 of 100,000 and 33 of 1000, while country rates are 1000 of 100,000 and 101 of 1000. HIV risk reduction was 93% and HIV-free survival at 12 months was 94%. CONCLUSIONS: Late postnatal transmission of HIV-1 is significantly decreased by maternal use of HAART with high infant survival rates up to 12 months of age. SN - 0891-3668 UR - https://www.unboundmedicine.com/medline/citation/19483516/Increased_infant_human_immunodeficiency_virus_type_one_free_survival_at_one_year_of_age_in_sub_saharan_Africa_with_maternal_use_of_highly_active_antiretroviral_therapy_during_breast_feeding_ L2 - https://doi.org/10.1097/INF.0b013e3181950c56 DB - PRIME DP - Unbound Medicine ER -