Comparison of 6-week PMTCT outcomes for HIV-exposed and HIV-unexposed infants in the era of lifelong ART: Results from an observational prospective cohort study.

Appolinaire Tiam,Irene Seipati,Mosilinyane Letsie,Laura Guay,Thorkild Tylleskär,Michelle M Gill,Mots’Oane Tsietso,Vincent Tukei,Seble G Kassaye,Anthony Isavwa,Rhoderick Machekano,Janety Barasa,Majoalane Mokone,Marcel Yotebieng

doi:10.1371/journal.pone.0226339

Abstract

Lifelong antiretroviral therapy (ART) reduces mother-to-child HIV transmission (MTCT) and improves maternal health. Data on the outcomes of HIV-exposed infants (HEI) compared to their unexposed counterparts in the era of universal ART is limited. We compared birth and 6-week outcomes among infants born to HIV-positive and HIV-negative women in Lesotho. 941 HIV-negative and 653 HIV-positive pregnant women were enrolled in an observational cohort to evaluate the effectiveness of prevention of mother-to-child HIV transmission (PMTCT) program after implementation of universal maternal ART in 14 health facilities. Pregnancy, delivery, birth, and 6-week data were collected through participant interviews and medical record review. DNA PCR testing for HEI was conducted within 2 weeks of birth and at around 6 weeks of age. Data were analysed to estimate the distribution of birth outcomes, mortality, HIV transmission and HIV-free survival at 6 weeks. HIV-positive women were older (mean age of 28.7 vs. 24.4 years) and presented for antenatal care earlier (mean gestational age of 23.0 weeks vs 25.3 weeks) than HIV-negative women. Prematurity was more frequent among HEI, 7.8% vs. 3.6%. There was no difference in rates of congenital anomalies between HEI (1.0%) and HIV-unexposed infants (HUI) (0.6%). Cumulative HIV transmission was 0.9% (N = 4/431) (95% CI:0.25-2.36) at birth and 1.0% (N = 6/583) (95% CI:0.38-2.23) at 6 weeks. Overall mortality, including stillbirths, was 5.2% and 6.0% by 6 weeks for HUI and HEI respectively. Among liveborn infants, 6-week HIV-free survival for HEI was 95.6% (95% CI:93.7-97.1) compared to 96.8% (95% CI:95.4-97.9) survival for HUI. Implementation of universal maternal ART lowers MTCT at 6 weeks of age with no differences in congenital anomalies or early mortality between HIV exposed Infants and HIV unexposed infants. However, HIV exposed infants continue to have high rates of prematurity despite improved maternal health on ART.

Highlights

Effective prevention of mother to child transmission (PMTCT) programs offering universal life-long antiretroviral therapy (ART) reduce HIV transmission to children from their mother and improve maternal health [1,2]
There was no difference in rates of congenital anomalies between HIV-exposed infants (HEI) (1.0%) and HIV-unexposed infants (HUI) (0.6%)
A critical question remains as to whether the reduction in mother-to-child HIV transmission (MTCT) rates and improvement in maternal health are coupled with improvement in birth outcomes and survival among HIV-exposed infants (HEI) to match those of HIV-unexposed infants (HUI)

Summary

Introduction

Effective prevention of mother to child transmission (PMTCT) programs offering universal life-long antiretroviral therapy (ART) reduce HIV transmission to children from their mother and improve maternal health [1,2]. There have been conflicting data reported on birth outcomes among HIV-positive women who are on lifelong ART compared to HIV negative women. In Rwanda, a study measuring HIV-free survival in a cohort of HEI, found a 6-week Mother to child transmission rate of 0.5% (95% CI:0.2–1.6) demonstrating the effectiveness of lifelong ART for HIV-positive pregnant women in preventing perinatal HIV transmission [11]. Lifelong antiretroviral therapy (ART) reduces mother-to-child HIV transmission (MTCT) and improves maternal health. Data on the outcomes of HIV-exposed infants (HEI) compared to their unexposed counterparts in the era of universal ART is limited.

Methods

Results

Conclusion