Improving outcomes in infants of HIV-infected women in a developing country setting

• Published in: PloS one 2008-11, Vol.3 (11), p.e3723-e3723
• Main Authors: Noel, Francine, Mehta, Sapna, Zhu, Yuwei, Rouzier, Patricia De Matteis, Marcelin, Abdias, Shi, Jian R, Nolte, Claudine, Severe, Linda, Deschamps, Marie Marcelle, Fitzgerald, Daniel W, Johnson, Warren D, Wright, Peter F, Pape, Jean W
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Analysis; Antiretroviral agents; Antiretroviral drugs; Antiretroviral Therapy, Highly Active; Antiviral agents; Birth weight; Cohort Studies; Data processing; Developing Countries; Disease transmission; Female; Highly active antiretroviral therapy; HIV; HIV infections; HIV Infections - drug therapy; HIV Infections - mortality; HIV Infections - prevention & control; HIV Infections - transmission; HIV patients; HIV-1 - physiology; Human immunodeficiency virus; Humans; Infant; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases - mortality; Infant, Newborn, Diseases - prevention & control; Infants; Infectious Disease Transmission, Vertical - prevention & control; Infectious Diseases/HIV Infection and AIDS; LDCs; Low birth weight; Mortality; Multivariate analysis; Patient outcomes; Pediatrics and Child Health; Prophylaxis; Public Health and Epidemiology/Global Health; Public Health and Epidemiology/Infectious Diseases; Risk analysis; Risk Factors; Syphilis; Therapy; Treatment Outcome; Womens health
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0003723

Since 1999 GHESKIO, a large voluntary counseling and HIV testing center in Port-au-Prince, Haiti, has had an ongoing collaboration with the Haitian Ministry of Health to reduce the rate of mother to child HIV transmission. There are limited data on the ability to administer complex regimens for reducing mother to child transmission and on risk factors for continued transmission and infant mortality within programmatic settings in developing countries. We analyzed data from 551 infants born to HIV-infected mothers seen at GHESKIO, between 1999 and 2005. HIV-infected mothers and their infants were given "short-course" monotherapy with antiretrovirals for prophylaxis; and, since 2003, highly active antiretroviral therapy (HAART) when clinical or laboratory indications were met. Infected women seen in the pre-treatment era had 27% transmission rates, falling to 10% in this cohort of 551 infants, and to only 1.9% in infants of women on HAART. Mortality rate after HAART introduction (0.12 per year of follow-up [0.08-0.16]) was significantly lower than the period before the availability of such therapy (0.23 [0.16-0.30], P