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doi: 10.1097/QAD.0b013e32833ff58c
Clinical Science

Extended antenatal antiretroviral use correlates with improved infant outcomes throughout the first year of life

Marazzi, Maria C; Liotta, Giuseppe; Nielsen-Saines, Karin; Haswell, Jere; Magid, Nurja A; Buonomo, Ersilia; Scarcella, Paola; Altan, Anna M Doro; Mancinelli, Sandro; Palombi, Leonardo

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Objectives: To evaluate the effect of extended antenatal triple antiretroviral therapy (ART) on infant outcomes.

Design: Retrospective cohort study using pooled data from health clinics in Malawi and Mozambique from July 2005 to December 2009.

Methods: Computerized records of 3273 HIV-infected pregnant women accessing Drug Resource Enhancement Against AIDS and Malnutrition centers were reviewed. ART regimens consisted of nevirapine-based HAART as of 14–25 weeks gestation until 6 months postpartum. Infant infection was determined at 1, 6 and 12 months of age by branched DNA.

Results: A total of 3071 pregnancies resulted in 3148 live births. Lost to follow-up, infant deaths and HIV-1 infection rates at 1 and 12 months were 1.3 and 11.5, 0.8 and 6.7 and 0.8 and 2.0, respectively. Infant HIV-1-free survival at 12 months was 92.5%. Mother-to-child transmission and/or infant deaths correlated with length of maternal antenatal ART by multivariate analysis at 1, 6 and 12 months: 14% in women with more than 30 days of triple antenatal ART and 6.9% in mothers receiving at least 90 days of antenatal ART, P = 0.001. Fifty percent of 54 episodes of transmission occurred in women with higher CD4 cell counts (>350 cells/μl). Infant mortality was 67/1000, lower than background rates (78–100/1000). Growth failure (weight-for-age Z score <−2) was present in 8% of infants around birth, 6% at 6 months, 23% at 12 months (lower than country-specific rates).

Conclusion: Extended antenatal ART is protective against adverse infant outcomes up to 12 months of age even in children born to mothers with higher CD4 cell counts.

© 2010 Lippincott Williams & Wilkins, Inc.


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