Abstract
BackgroundMultidrug antiretroviral (ARV) regimens including HAART and short-course dual antiretroviral (sc-dARV) regimens were introduced in 2004 to improve Prevention of Mother-to-Child Transmission (PMTCT) in Cameroon. We assessed the effectiveness of these regimens from 6–10 weeks and 12 months of age, respectively.Methodology/FindingsWe conducted a retrospective cohort study covering the period from October 2004 to March 2008 in a reference hospital in Cameroon. HIV-positive pregnant women with CD4 ≤350 cells/mm3 received first-line HAART [regimen 1] while the others received ARV prophylaxis including sc-dARV or single dose nevirapine (sd-NVP). Sc-dARV included at least two drugs according to different gestational ages: zidovudine (ZDV) from 28–32 weeks plus sd-NVP [regimen 2], ZDV and lamuvidine (3TC) from 33–36 weeks plus sd-NVP [regimen 3]. When gestational age was ≥37 weeks, women received sd-NVP during labour [regimen 4]. Infants received sd-NVP plus ZDV and 3TC for 7 days or 30 days. Early diagnosis (6–10 weeks) was done, using b-DNA and subsequently RT-PCR. We determined early MTCT rate and associated risk factors using logistic regression. The 12-month HIV-free survival was assessed using Cox regression. Among 418 mothers, 335 (80%) received multidrug ARV regimens (1, 2, and 3) and MTCT rate with multidrug regimens was 6.6% [95%CI: 4.3–9.6] at 6 weeks, without any significant difference between regimens. Duration of mother's ARV regimen <4 weeks [OR = 4.7, 95%CI: 1.3–17.6], mother's CD4 <350 cells/mm3 [OR = 6.4, 95%CI: 1.8–22.5] and low birth weight [OR = 4.0, 95%CI: 1.4–11.3] were associated with early MTCT. By 12 months, mixed feeding [HR = 8.7, 95%CI: 3.6–20.6], prematurity [HR = 2.3, 95%CI: 1.2–4.3] and low birth weight were associated with children's risk of progressing to infection or death.ConclusionsMultidrug ARV regimens for PMTCT are feasible and effective in routine reference hospital. Early initiation of ARV during pregnancy and proper obstetrical care are essential to improve PMTCT.
Highlights
Infection due to Human Immunodeficiency Virus type 1 (HIV-1) is one of the main causes of morbidity and mortality among children in Africa [1,2]
Multidrug ARV regimens for Prevention of Mother-to-Child Transmission (PMTCT) are feasible and effective in routine reference hospital
Mother-To-Child Transmission (MTCT) rates as low as 5.6% was reported with short-course multidrug ARV regimens combined with shortened breastfeeding in a research setting in Abidjan [11]
Summary
Infection due to Human Immunodeficiency Virus type 1 (HIV-1) is one of the main causes of morbidity and mortality among children in Africa [1,2]. In resource-constrained settings, elective caesarean delivery is seldom feasible [7] and it is often neither acceptable nor safe for mothers to refrain from breastfeeding. In these settings, initial efforts to prevent HIV infection in infants were focused on reducing MTCT around the period of labour and delivery, which accounts for one to two thirds of the overall transmission, depending on whether the mother breastfeeds or not. Multidrug antiretroviral (ARV) regimens including HAART and short-course dual antiretroviral (sc-dARV) regimens were introduced in 2004 to improve Prevention of Mother-to-Child Transmission (PMTCT) in Cameroon. We assessed the effectiveness of these regimens from 6–10 weeks and 12 months of age, respectively
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