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Effects of Highly Active Antiretroviral Therapy Duration and Regimen on Risk for Mother-to-Child Transmission of HIV in Johannesburg, South Africa

Hoffman, Risa M MD, MPH*; Black, Vivian BSc (Wits), MBBCh (Wits), DTM&H (SA), Dip HIV Man (SA); Technau, Karl MBBCH, Dip Hiv Man (SA), DCH (SA); van der Merwe, Karin Joan MBBCH, Dip Hiv Man (SA), DCH (SA); Currier, Judith MD, MSc*; Coovadia, Ashraf MB.ChB (UNZA), DCH (SA), Dip HIV Man (SA) FCP (SA) Paed; Chersich, Matthew MBBCh (Wits), MSc (LSHTM), PhD (U.Gent), DFPH (UK)†§

JAIDS Journal of Acquired Immune Deficiency Syndromes: May 1st, 2010 - Volume 54 - Issue 1 - p 35-41
doi: 10.1097/QAI.0b013e3181cf9979
Clinical Science

Background: Limited information exists about effects of different highly active antiretroviral therapy (HAART) regimens and duration of regimens on mother-to-child transmission (MTCT) of HIV among women in Africa who start treatment for advanced immunosuppression.

Methods: Between January 2004 to August 2008, 1142 women were followed at antenatal antiretroviral clinics in Johannesburg. Predictors of MTCT (positive infant HIV DNA polymerase chain reaction at 4-6 weeks) were assessed with multivariate logistic regression.

Results: Mean age was 30.2 years (SD = 5.0) and median baseline CD4 count was 161 cells per cubic millimeter (SD = 84.3). HAART duration at time of delivery was a mean 10.7 weeks (SD = 7.4) for the 85% of women who initiated treatment during pregnancy and 93.4 weeks (SD = 37.7) for those who became pregnant on HAART. Overall MTCT rate was 4.9% (43 of 874), with no differences detected between HAART regimens. MTCT rates were lower in women who became pregnant on HAART than those initiating HAART during pregnancy (0.7% versus 5.7%; P = 0.01). In the latter group, each additional week of treatment reduced odds of transmission by 8% (95% confidence interval: 0.87 to 0.99, P = 0.02).

Conclusions: Late initiation of HAART is associated with increased risk of MTCT. Strategies are needed to facilitate earlier identification of HIV-infected women.

From the *David Geffen School of Medicine at UCLA, Division of Infectious Diseases and Center for Clinical AIDS Research and Education, Los Angeles, CA; †Reproductive Health and HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa; ‡Rahima Moosa Mother and Child Hospital, Enhancing Children's HIV Outcomes (ECHO), University of the Witwatersrand, Johannesburg, South Africa; and §Department of Obstetrics and Gynaecology, University of Gent, Gent, Belgium.

Received for publication August 3, 2009; accepted November 2, 2009.

Supported by PEPFAR, South African Department of Public Health.

Presented in poster format at the 5th International AIDS Conference on HIV Pathogenesis, Treatment and Prevention, July 22, 2009, Capetown, South Africa.

Correspondence to: Dr. Risa M. Hoffman, MD, MPH, University of California, Los Angeles, Division of Infectious Diseases, 10833 Le Conte Ave 37-121 CHS, Los Angeles, CA 90095 (e-mail: rhoffman@mednet.ucla.edu).

© 2010 Lippincott Williams & Wilkins, Inc.