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Extended use of highly active antiretroviral therapy (HAART) during pregnancy in Southern Africa is highly protective in HIV-1 prevention of mother-to-child-transmission (PMTCT) also in women with higher CD4 cell counts
Presented by Leonardo Palombi (Italy).
M.C. Marazzi1,2, G. Liotta3, J. Haswell4, I. Zimba5, K. Nielsen-Saines6, M. Maulidi7, N. Abdul Magid5, D. Thole8, E. Buonomo3, P. Scarcella3, G. Paturzo9, A.M. Doro Altan3, S. Mancinelli3, L. Palombi1,3
1Community of Sant'Egidio, DREAM program, Rome, Italy, 2LUMSA University, Rome, Italy, 3University of Tor Vergata, Public Health, Rome, Italy, 4DREAM Program, Community of S. Egidio, Blantyre, Malawi, 5DREAM Program, Community of S. Egidio, Maputo, Mozambique, 6UCLA, Pediatrics, Los Angeles, United States, 7DREAM Program, Community of S. Egidio, Lilongwe, Malawi, 8DREAM Program, Community of S. Egidio, Balaka, Malawi, 9DREAM Program, Community of S. Egidio, Rome, Italy
Background: There is significant variability in maternal treatment regimens for PMTCT purposes in resource limited settings. The burning question is: which regimen is most beneficial in women with higher CD4 counts? We evaluated outcomes in our HAART-based PMTCT program in Sub-Saharan Africa.
Methods: Files for 3,148 live births from HIV+ women acessing DREAM centers from 7/2005 to 12/2008 were reviewed. Women were offered nevirapine based HAART at 14 weeks (if required for own health) or 25 weeks gestation until 6 months postpartum. HIV-1 infection in infants was determined by bDNA.
Results: A total of 3,079 infants completed their 1 month follow-up visit including 333 awaiting PCR results. An additional 5 died (0.2%) and 64 (2.0%) were lost to follow-up prior to the 1 month visit. HIV-1 transmission rate at 1 month was 1% (28/2,746): 0.9% (26/2,707) in mothers who received at least one dose of HAART before delivery (VLLog 3.55) and 5.1% (2/39) in women who did not initiate HAART until delivery (VLLog 4.51) (p< 0.001). HIV-1 free survival at 1 month was 98.8% (2,718/2,751). Multivariate analysis demonstrated an association between HAART exposure pre-delivery (no HAART, 1-30 days, 31-90, >90) and HIV transmission at 1 month and death (OR 0.57; CL95% 0.36-0.88 adjusted for baseline Viral Load, CD4, Hemoglobin and Body Mass Index). Mothers with baseline CD4 counts > 350 comprised 31% of transmissions (10/32). Transmission was 2.4% in women with < 30 days of HAART exposure and 1.0% in women with HAART >30 days.
[HIV positivity + Death (one month)]
Conclusion: The benefits of HAART during pregnancy for HIV-1 PMTCT are extensive to women with higher CD4 counts. Best results occur with longer duration of treatment.
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