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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‡

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

Author Information

From the *Department of Public Health, LUMSA University, Rome, Italy; †Department of Pediatrics, David Geffen UCLA School of Medicine, Los Angeles, CA; ‡Department of Public Health, Tor Vergata University, Rome, Italy; §Community of Sant'Egidio, Rome, Italy; ¶Benfica Health Center, Maputo, Mozambique; and ∥Machava Health Center, Maputo, Mozambique.

Accepted for publication November 13, 2008.

The DREAM (Drug Resource Enhancement Against AIDS and Malnutrition) Program, of the Sant'Egidio Community, Rome, Italy is supported by multiple organizations including the World Bank Treatment Acceleration Program (TAP), several Italian private banks, several governmental cooperations including the German Agency for Technical Cooperation, the Agence Française de Développement, the Catalan Agency for Development Cooperation, the Belgium Development Cooperation, and the United States President Emergency Plan for AIDS Relief (PEPFAR) among others.

Results of this study were presented at the 15th Conference on Retroviruses and Opportunistic Infections held in Boston, MA from February 3 to 6, 2008 (Abstract 639).

The present manuscript was not funded by a specific award.

Address for correspondence: Karin Nielsen-Saines, MD, MPH, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, MDCC 22-442 10833 LeConte Ave, Los Angeles, CA 90095. E-mail: knielsen@mednet.ucla.edu.

© 2009 Lippincott Williams & Wilkins, Inc.