Effectiveness of option B highly active antiretroviral therapy (HAART) prevention of mother-to-child transmission (PMTCT) in pregnant HIV women

Abstract

BackgroundEnsuring that no baby is born with HIV is an essential step towards achieving an AIDS-free generation. To achieve this, strategies that decouple links between childbirth and HIV transmission are necessary. Traditional forms of prevention of mother-to-child transmission of HIV (PMTCT), has been recommended. Recognizing the importance and challenges of combination of methods to achieve rapid PMTCT, the World Health Organization (WHO) recommended option B Highly Active Antiretroviral Therapy (HAART) for all HIV-positive pregnant women. This study aimed to evaluate the effectiveness of the HAART in PMTCT. A cohort of HIV-infected pregnant women in Kenya were obtained from the DREAM Center, Nairobi. The study participants underwent adherence counselling and Option B of HAART [Nevirapine(NVP) + Lamivudine + Zidovudine] at the fourth week of gestation followed by an intravenous NVP administration intrapartum and postpartum NVP syrup to the respective infants for six weeks. Absolute pre-HAART and post-HAART CD4 counts and viral loads counts were determined. Comparison of the CD4 counts and viral loads before and after administration of HAART were done using Wilcoxon’s Matched Pairs Signed-Ranks Test.FindingsThe mean absolute CD4 cell counts in mothers after administration of HAART was significantly higher (Z = 15.664, p < 0.001) than before the administration of HAART). Also the viral load of the mothers significantly (Z = 11.324, p < 0.001) reduced following HAART treatment. Following the HAART administration in mothers, up to 90% of children were confirmed to be HIV negative.ConclusionAdministration of HAART to mothers and children demonstrated an effective mechanism of PMTCT. However, other aspects of HAART such as adherence, costs, mothers behaviour during HAART, and the child feeding programme during the therapy should further be evaluated and ascertained how they can affect the overall efficacy of option B HAART in PMTCT.

Progress Toward Eliminating Mother to Child Transmission of HIV in Kenya: Review of Treatment Guideline Uptake and Pediatric Transmission at Four Government Hospitals Between 2010 and 2012

“…In contrast to our expectations and the existing literature evaluating PMTCT treatment regimens, [ 26 – 28 ] the earlier administration of more rigorous PMTCT regimens was not significantly associated with decreased infant HIV transmission when analyzed at the individual level. It’s possible that these data on initial regimen and timing of initiation, which were recorded by healthcare providers in clinical records, were not a perfect reflection of what mothers really ended up taking during their pregnancies.…”

Fetal outcome of HIV positive pregnant women taking highly active antiretroviral therapy at Yaoundé Central Hospital: a cross sectional analytic study

“…This then confirms the findings of Baker et al who said that formal schooling adds significant value to innate ability in the form of higher-order cognitive skills crucial to decisions about health. 16 Nonetheless the present findings of more women in the tertiary group was contradicted by the findings of Ngemu et al In that said that most of the pregnant women on HAART where having at most a secondary level of education Kenya. 17 This difference might be explained by the general improvement of education in all the sectors in developing countries.…”

Prevalence and associated factors of HIV infection among pregnant women attending antenatal care at the Yaoundé central hospital

“…The Knowledge of status of pregnant women could reduce the risk of vertical transmission of HIV through the interventions of Prevention of mother to child. 3 Our objective was to determine the prevalence and factors associated with HIV infection among pregnant women attending antenatal care (ANC) at the Yaoundé Central Hospital (YCH), and to identify factors associated with HIV infection in this population.…”