This article is more than 5 years old. Information may no longer be current.
Pre-conception ART most effective for preventing mother-to-child HIV transmission
Recent study data revealed that pre-conception ART was the most effective in reducing the incidence mother-to-child transmission of HIV in Zimbabwe.
“Globally there has been dramatic progress in reducing new pediatric HIV infection by 58% from 2000 to 2014,” Thu-Ha Dinh, MD, MS, of the CDC, and colleagues wrote. “This achievement is mostly attributable to the successful implementation of national programs to prevention of mother-to-child HIV transmission. The impact of [prevention of mother-to-child transmission] depends on the coverage and timing of triple ART.”
The researchers conducted an observational cohort study of 6,051 infants aged 4 to 12 weeks, as well as their mothers, from 151 immunization clinics in Zimbabwe. Dinh and colleagues conducted their study beginning in 2013 and continuing through the 18-month period during which Zimbabwe transitioned to Option Plan B+, a national test-and-treat program for all pregnant or breastfeeding women with HIV. A total of 1,172 infants had been exposed to HIV; Dinh and colleagues evaluated these infants at baseline and every 3 months until the child developed HIV, reached age 18 months or died.
The cumulative risk of mother-to-child transmission in the first 18 months of life was 7%, the researchers reported. Among the women who had HIV, 35.3% began ART before conception, 9.7% after delivery and 28.9% during pregnancy. Sixteen percent received zidovudine while pregnant.
Women who started ART before conception had an 88% mother-to-child transmission rate compared with those who did not undergo any ART (adjusted HR = 0.12; 95% CI, 0.06-0.24), while those who received ART while pregnant had a 75% lower rate (aHR = 0.25; 95% CI, 0.14-0.45), Dinh and colleagues wrote.
Infants exposed to HIV and born at a birthweight of less than 2.5 kg were 2.6-fold more likely to develop HIV than those with a birthweight of at least 2.5 kg (aHR = 2.57; 95% CI, 1.44-4.59). However, after Dinh and colleagues controlled for other factors, they reported no significant association between breastfeeding and mother-to-child transmission.
“Elimination of [mother-to-child transmission] is achievable in limited-resource settings where breastfeeding is a norm,” the researchers wrote. “ART pre-conception has the highest impact on reducing [mother-to-child transmission]; therefore, HIV-infected women of reproductive age should be prioritized in the ‘treat-all’ approach to eliminating [mother-to-child transmission].” – by Andy Polhamus
Disclosures: The authors report no relevant financial disclosures.