Abstract
BackgroundIndia lacks data on the incidence of Paediatric HIV. In 2010, the Indian Council of Medical Research commissioned a task force study to estimate the paediatric HIV burden in Belgaum district, Karnataka, India. We estimated the HIV incidence, prevalence and associated risk factors of mother to child transmission of HIV among children exposed to maternal HIV by age 24 months.MethodsWe included Belgaum resident pregnant women who tested HIV positive between January 1st, 2011 and May 31st, 2013 and who provided consent. Their babies were tested for HIV at three time intervals using DNA PCR dry blood spot (DBS) method at 6–10 weeks and 6–9 months, and using Antibody tests at 18–24 months of age. We estimated cumulative incidence using survival analysis that considered censoring of cases and prevalence rates of HIV by age 24 months. Using competing-risk survival regression model, we examined the correlates of transmission of HIV among babies exposed to maternal HIV.ResultsAmong 487 children of HIV positive mothers recruited in the study, the cumulative incidence rate by 24 months of age was 4.8 per 1000 person months [95% CI: 3.5–6.6]. The HIV prevalence rate among babies exposed to maternal HIV until 24 months was 7.8% [95% CI: 5.7–10.7]. Mother’s age above 30 years, and breastfeeding duration of more than six months were factors that significantly increased the HIV transmission; adjusted hazard ratio (AHR) 6.98 [95% CI: 1.73–28.16] and 5.28 [95% CI, 1.75–15.90], respectively. The risk of MTCT was significantly reduced if both mother and baby had received Nevirapine at delivery [AHR 0.25; 95%CI: 0.10–0.61] and if either mother or baby had been given Nevirapine at delivery [AHR 0.12; 95%CI: 0.03–0.49].ConclusionThe study findings suggest that mother’s age above 30 years and breastfeeding beyond 26 weeks is associated with higher rates of HIV transmission from mother to child. It confirms the benefits of providing anti-retrovirals (Nevirapine) in reducing mother to child transmission of HIV. Effective strategies to promote safe infant feeding practices, including avoidance of mixed feeding beyond 26 weeks among HIV infected mothers, is critical to reduce incidence of paediatric HIV in India.
Highlights
India lacks data on the incidence of Paediatric human immunodeficiency virus (HIV)
We recruited 469 HIV infected mothers who had delivered between 2011 and 2013, and who consented to participate in the cohort study
Among the babies who died, 16 babies died before 28 days of age, 15 babies died between 28 days and 1 year of age and the remaining 2 babies died after 1 year of age
Summary
India lacks data on the incidence of Paediatric HIV. In 2010, the Indian Council of Medical Research commissioned a task force study to estimate the paediatric HIV burden in Belgaum district, Karnataka, India. We estimated the HIV incidence, prevalence and associated risk factors of mother to child transmission of HIV among children exposed to maternal HIV by age 24 months. Following the landmark research study on prevention of vertical HIV transmission by the AIDS Clinical Trial Group (ACTG-076) in 1994 [3], there have been significant efforts in India to scale up the coverage of HIV testing and counselling, to prevent linkage loss for treatment initiation for those mothers detected HIV infected and to ensure early infant diagnosis and initiation of treatment for infants detected to have HIV [2]. Following the new WHO (2013) guidelines (called Option B+), NACO initiated the provision of life-long (triple drug regimen) Anti-retroviral treatment (ART) to all pregnant and breastfeeding women living with HIV effective from January 2014 [2]
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