Abstract
Background: In Cameroon, the prevalence of HIV in pregnant women was 7.8% in 2012, and they were 8500 HIV positive newborns in 2013. Option B+ is the first highly active antiretroviral therapy (HAART) preventive protocol. The objective was to evaluate the rate of HIV transmission on children born from mothers who were on Option B+ during pregnancy, in three university teaching hospitals of the University of Yaounde I. Methods: It was a retrospective, cross-sectional study over a period of four years (2013-2017). We included HIV positive mothers not on previous antiretroviral treatment and who received a single tablet daily of combined tenofovir (300 mg) + Lamivudine (300 mg) + Efavirenz (600 mg) started at any time during pregnancy. Newborn received nevirapine syrup according to WHO option B+ protocol. Results: 179 women were included. The average age was 33.5 ± 2.92 years, all ages were represented. Blood donation was the most frequent HIV positive screening opportunity, voluntary testing rate was 29% (29/179), and adherence rate was 98.9%. Few male partners were involved (58/179). Premature deliveries and low birth weight were rare (5/179; 10/179)), the indication of mode of delivery was strictly obstetrical, newborn feeding choice didn’t affect the transmission outcome, and the mother to child transmission rate was 2.2% (4/179). Conclusion: Option B+ could achieve the lowest mother to child transmission ever in Cameroon and should be generalized in high endemicity low resources settings.
Highlights
The objective was to evaluate the rate of HIV transmission on children born from mothers who were on Option B+ during pregnancy, in three university teaching hospitals of the University of Yaoundé I
AIDS is the leading cause of adolescent death around the world with 328 deaths every day [1]. This transmission can occur during pregnancy, labor, delivery or breastfeeding and can be eliminated if HIV positive (HIV+) mothers have access to prevention of mother to child transmission (PMTCT) programs [2]
Cameroon, a country with generalized epidemiology, has adopted the protocol named Option B+, to further reduce mother to child transmission of HIV since 2013. It is the administration of highly active antiretroviral therapy (HAART) to all HIV+ positive pregnant women once diagnosed, regardless of CD4 count and viral load for life, and nevirapine syrup to the new born
Summary
Mother to child transmission of HIV represents 90% of HIV transmission among children less than 14 years and, globally, it was still the seventh leading cause of death among children aged 10 - 14 years in 2015, and the ninth of death among adolescents (aged 10 - 19 years). Cameroon, a country with generalized epidemiology, has adopted the protocol named Option B+, to further reduce mother to child transmission of HIV since 2013 It is the administration of highly active antiretroviral therapy (HAART) to all HIV+ positive pregnant women once diagnosed, regardless of CD4 count and viral load for life, and nevirapine syrup to the new born. This protocol has reduced the mother to child transmission rate from 18% to 2.2% in Ethiopia [7], and to 3.5% in Malawi [8], but no study assessing the mother to child transmission rate of HIV after option B+ has ever been conducted in the three major university PMTCT centers in the capital city of that country, including data concerning male partners involvement and HIV-exposed-children feeding mode assessment and HIV status outcome. Conclusion: Option B+ could achieve the lowest mother to child transmission ever in Cameroon and should be generalized in high endemicity low resources settings
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