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Infant extended antiretroviral (ARV) prophylaxis is effective in preventing postnatal mother-to-child HIV transmission (MTCT) at all maternal CD4 counts
Presented by Lynne M Mofenson (United States).
L.M. Mofenson1, T.E. Taha2, Q. LI2, J. Kumwenda3, G. Kafulafula4, M.G. Fowler4, D.R. Hoover5, M. Thigpen6, N.I. Kumwenda3, and the PEPI Malawi Study Group
1Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, United States, 2Johns Hopkins Bloomberg School of Public Health, Baltimore, United States, 3University of Malawi College of Medicine, Blantyre, Malawi, 4Johns Hopkins University Medical Institutions, Baltimore, United States, 5Rutgers University, Piscataway, United States, 6Centers for Disease Control and Prevention, Atlanta, United States
Background: We previously reported that antiretroviral post-exposure prophylaxis of infants (PEPI) to age 14 weeks significantly reduces postnatal HIV MTCT. In this analysis we assessed whether baseline maternal CD4 count affected the efficacy of extended infant prophylaxis.
Methods: In the Malawi PEPI trial, breastfeeding HIV-uninfected infants were randomized at birth to 3 arms: control (single-dose nevirapine [NVP]+1 wk zidovudine [ZDV]), and control plus either NVP only or NVP+ZDV to age 14 wks. Maternal baseline CD4 count was obtained between delivery and 3 days postpartum. Kaplan-Meier (K-M) curves were calculated stratified by maternal CD4 category (< 200, 200-350, >350). We analyzed postnatal MTCT rates at age 14 weeks (when intervention stopped).
Results: The table shows postnatal HIV transmission rates (95% confidence intervals [CI]) at age 14 weeks in infants uninfected at birth, and relative risk [RR] (95% CI) of MTCT in extended compared to control arms.
[pepi table]
Conclusions: Extended infant ARV prophylaxis was effective at all maternal CD4 counts. However, even with infant prophylaxis, postnatal infection rates for mothers with CD4 < 350 (the current eligibility threshold for treatment in developed countries) was still substantial. Postnatal transmission rates with extended infant NVP prophylaxis for women with CD4 >350 were low (1.4%) and similar to what has been reported with maternal HAART prophylaxis (Thomas T, KIBS study, 15th CROI, 2008, Abs 45aLB - postnatal MTCT in women with CD4 >250 on HAART at age 12 wks, 1.7%).
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