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Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e3181950c56
Original Studies

Increased Infant Human Immunodeficiency Virus-Type One Free Survival at One Year of Age in Sub-Saharan Africa With Maternal Use of Highly Active Antiretroviral Therapy During Breast-Feeding

Marazzi, Maria Cristina MD*; Nielsen-Saines, Karin MD†; Buonomo, Ersilia MD‡; Scarcella, Paola MD‡; Germano, Paola MS§; Majid, Nuria Abdul MD¶; Zimba, Ines MD∥; Ceffa, Susanna PhD§; Palombi, Leonardo MD‡

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Abstract

Background: Reduction of HIV-1 breast-feeding transmission remains a challenge for prevention of pediatric infections in Sub-Saharan Africa. Provision of formula decreases transmission but often increases child mortality in this setting.

Methods: A prospective observational cohort study of HIV-1 exposed infants of mothers receiving pre and postnatal medical care at Drug Resource Enhancement Against AIDS and Malnutrition centers in Mozambique was conducted. Live-born infants of HIV-1-infected women receiving medical care were enrolled. HIV-1 testing was performed at 1, 6, and 12 months of age using branched DNA. Mothers were counseled to breast-feed exclusively for 6 months and were provided HAART antenatally and postnatally for the first 6 months. Women with CD4 cell counts less than 350/cmm at baseline continued HAART indefinitely.

Results: Of 341 infants followed from birth, 313 mother-infant pairs (92%) completed 6 months and 283 (83%) completed 12 months of follow-up. HIV-1 diagnosis was ascertained in 287 infants (84%) including 4 who died. There were 8 cases of HIV-1 transmission: 4 of 341 (1.2%) at 1 month, 2 of 313 (0.6%) at 6 months, and 2 of 276 (0.7%) at 12 months (cumulative rate: 2.8%). Two mothers (0.6%) and 11 infants (3.2%) died. Maternal and infant mortality rates were 587 of 100,000 and 33 of 1000, while country rates are 1000 of 100,000 and 101 of 1000. HIV risk reduction was 93% and HIV-free survival at 12 months was 94%.

Conclusions: Late postnatal transmission of HIV-1 is significantly decreased by maternal use of HAART with high infant survival rates up to 12 months of age.

© 2009 Lippincott Williams & Wilkins, Inc.

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