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 mid 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 9 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.

Marazzi, M., Nielsen Saines, K., Buonomo, E., Scarcella, P., Germano, P., Majid, N., et al. (2009). 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. THE PEDIATRIC INFECTIOUS DISEASE JOURNAL, 28(6), 483-487 [10.1097/INF.0b013e3181950c56].

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

BUONOMO, ERSILIA;SCARCELLA, PAOLA;PALOMBI, LEONARDO
2009-10-28

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 mid 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 9 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.
Pubblicato
Rilevanza internazionale
Articolo
Sì, ma tipo non specificato
Settore MED/42 - Igiene Generale e Applicata
English
Con Impact Factor ISI
Breast-feeding; HAART; HIV-1 mother-to-child transmission (MTCT); Sub-Saharan Africa
antiretrovirus agent; lamivudine; lopinavir plus ritonavir; nelfinavir; nevirapine; stavudine; zidovudine; Africa; article; breast feeding; CD4 lymphocyte count; cohort analysis; disease free survival; highly active antiretroviral therapy; human; Human immunodeficiency virus 1; Human immunodeficiency virus 1 infection; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; Human immunodeficiency virus prevalence; infant; infant mortality; infection risk; major clinical study; maternal mortality; mother; Mozambique; observational study; parent counseling; postnatal care; prenatal care; priority journal; prospective study; risk reduction; single drug dose; survival rate; treatment outcome; vertical transmission; virus load; virus transmission; Adult; Africa South of the Sahara; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Breast Feeding; Chi-Square Distribution; Disease-Free Survival; Female; HIV Infections; HIV-1; Humans; Infant; Infant, Newborn; Infectious Disease Transmission, Vertical; Kaplan-Meiers Estimate; Pregnancy; Pregnancy Complications, Infectious; Proportional Hazards Models; Viral Load
Marazzi, M., Nielsen Saines, K., Buonomo, E., Scarcella, P., Germano, P., Majid, N., et al. (2009). 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. THE PEDIATRIC INFECTIOUS DISEASE JOURNAL, 28(6), 483-487 [10.1097/INF.0b013e3181950c56].
Marazzi, M; Nielsen Saines, K; Buonomo, E; Scarcella, P; Germano, P; Majid, N; Zimba, I; Ceffa, S; Palombi, L
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/57687
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