Elimination of infant HIV in Zimbabwe associated with better access to antiretroviral medication, continued usage

Ciaranello AL. PLoS Med. 2012; doi:10.1371/journal.pmed.1001156.

Eradicating new infant HIV infections in Zimbabwe will require improved access to antiretroviral medications and support to help HIV-infected mothers continue taking their medication, according to a report published in the January issue of PLoS Medicine.

“Pediatric HIV infection has been nearly eliminated in resource-rich settings, such as the United States and Europe, through a combination of anti-HIV drugs and avoidance of breast-feeding,” Andrea Ciaranello, MD, MPH, of the Massachusetts General Hospital division of infectious diseases, said in a press release. “The World Health Organization has urged health programs throughout the world to aim for the same successes, calling for the ‘virtual elimination’ — defined as reducing transmission risk to less than 5% — of mother-to-child HIV transmission.”

An international research team investigated uptake of prevention of Zimbabwean mother-to-child HIV transmission services, infant feeding recommendations and specific drug regimens using a computer model to simulate two populations of HIV-infected pregnant/breast-feeding women (mean age, 24 years).

The researchers compared the current Zimbabwean prevention program, which provides three-drug antiretroviral therapy to pregnant women with advanced HIV infection and a single dose of the antiviral drug nevirapine for all others, with two updated antiviral options recommended by WHO in 2010.

The first option recommended by WHO guidelines involved zidovudine in pregnancy, infant nevirapine throughout breast-feeding for women without advanced disease and lifelong combination ART for women with advanced disease. The second WHO option included pregnancy/breast-feeding–limited combination antiretroviral drug regimens without advanced disease and lifelong ART with advanced disease.

Researchers examined the proportion of pregnant women accessing and adhering to prevention of mother-to-child HIV transmission services and reported rates of 36% in 2008 and 56% in 2009 vs. target goals of 80% in 2008 and 95% in 2009. The 2009 single-dose nevirapine-based Zimbabwean prevention program led to a projected transmission rate of 18%, an improvement from 20.3% the previous year.

According to the report, if single-dose nevirapine was replaced by more effective regimens, with 2009 (56%) uptake, estimated mother-to-child transmission risk would be 14.4% (with zidovudine) or 13.4% (with combination antiretroviral drug regimens). However, even with 95% uptake of more effective regimens, projected transmission risks (6.1%-7.7%) would exceed the WHO goal of less than 5%.

Disclosure: The researchers report no relevant financial disclosures.

Follow the PediatricSuperSite.com on Twitter.