HIV transmission and 24-month survival in a randomized trial of HAART to prevent MTCT during pregnancy and breastfeeding in Botswana

Shapiro, Roger; Kitch, Douglas; Ogwu, Anthony; Hughes, Michael D.; Lockman, Shahin; Powis, Kathleen M.; Souda, Sajini; Moffat, Claire; Moyo, Sikhulile; McIntosh, Kenneth; Widenfelt, Erik van; Zwerski, Sheryl; Mazhani, Loeto; Makhema, Joseph; Essex, Max

doi:10.1097/qad.0b013e32836158b0

Cited by 43 publications

(51 citation statements)

References 21 publications

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“…The seven cohorts nested within clinical trials evaluated the use of ART during pregnancy and post‐natally in reducing mother‐to‐child transmission (MTCT) of HIV and infant deaths . Cournil et al .…”

Section: Resultsmentioning

confidence: 99%

HIV‐free survival at 12–24 months in breastfed infants of HIV‐infected women on antiretroviral treatment

Chikhungu

Bispo

Rollins

et al. 2016

Tropical Med Int Health

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ObjectiveTo provide estimates of HIV‐free survival at 12–24 months in breastfed children by maternal ART (6 months or lifelong) to inform WHO HIV and Infant Feeding guidelines.MethodsEighteen studies published 2005–2015 were included in a systematic literature review (1295 papers identified, 156 abstracts screened, 55 full texts); papers were analysed by narrative synthesis and meta‐analysis of HIV‐free survival by maternal ART regimen in a random effects model. We also grouped studies by feeding modality. Study quality was assessed using a modified Newcastle–Ottawa Scale (NOS) and GRADE.ResultsThe pooled estimates for 12‐month HIV‐free survival were 89.8% (95% confidence interval, CI: 86.5%, 93.2%) for infants of mothers on ART for 6 months post‐natally (six studies) and 91.4% (95% CI 87.5%, 95.4%) for infants of mothers on lifelong ART (three studies). Eighteen‐month HIV‐free survival estimates were 89.0% (95% CI 83.9%, 94.2%) with 6 months ART (five studies) and 96.1% (95% CI 92.8%, 99.0%) with lifelong ART (three studies). Twenty‐four‐month HIV‐free survival for infants whose mothers were on ART to 6 months post‐natally (two studies) was 89.2% (95% CI 79.9%, 98.5%). Heterogeneity was considerable throughout. In four studies, HIV‐free survival in breastfed infants ranged from 87% (95% CI 78%, 92%) to 96% (95% CI 91%, 98%) and in formula‐fed infants from 67% (95% CI 35.5%, 87.9%) to 97.6% (95% CI 93.0%, 98.2%).ConclusionOur results highlight the importance of breastfeeding for infant survival and of ART in reducing the risk of mother‐to‐child HIV transmission and support the WHO recommendation to initiate ART for life immediately after HIV diagnosis.

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Section: Resultsmentioning

confidence: 99%

HIV‐free survival at 12–24 months in breastfed infants of HIV‐infected women on antiretroviral treatment

Chikhungu

Bispo

Rollins

et al. 2016

Tropical Med Int Health

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“…they may be unable to provide optimal breastfeeding – and this may jeopardize the children’s health and nutritional status 32 – 35 . Premature weaning, which is associated with higher mortality rates, especially for younger infants, may occur 7 , 23 , 33 , 36 . In settings where infant survival is highly dependent on continued breastfeeding, the loss of a father may not increase the risk of a child dying to the same extent as the loss of the mother 37 , 38 .…”

Section: Discussionmentioning

confidence: 99%

Under-five mortality according to maternal survival: a systematic review and meta-analysis

Chikhungu

Newell

Rollins

2017

Bull. World Health Organ.

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ObjectiveTo investigate, within so-called general populations, the relationship between maternal survival and mortality of children younger than five years.MethodsWe conducted a systematic review of literature published between January 1990 and November 2016 that reported maternal vital status and the corresponding mortality of children younger than five years. Seven studies were included in a qualitative analysis and four in a random-effects meta-analysis. Summary estimates of the odds of dying by maternal survival were obtained and statistical heterogeneity estimated. Quality of the included studies and evidence was assessed using a Cochrane tool for assessing risk of bias and the Grading of Recommendations Assessment, Development and Evaluation criteria, respectively.FindingsAmong children younger than five years, those whose mother had died were found to be 4.09 times (95% confidence interval, CI: 2.40–6.98) more likely to die than those with surviving mothers. Due to heterogeneity (I2: 83%), further pooled estimates were not possible. For children that were motherless as a result of maternal mortality, the increased odds of dying ranged from 1.40 (95% CI: 0.47–4.21) to 2.92 (95% CI: 1.21–7.04) among those aged between two and four years, 6.1 (95% CI: 2.27–16.77) to 33.78 (95% CI: 24.21–47.14) for those younger than one year and 4.39 (95% CI: 3.34–5.78) to 51.68 (95% CI: 20.26–131.80) for those younger than six months.ConclusionThe loss of a mother was associated with increased mortality among children, especially when maternal death occurred in the first year of the child’s life.

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“…These trials have included increasing duration of infant nevirapine (NVP) prophylaxis from 6 weeks up to 6 months [1–3], or ARV for the mother for up to 6 months [4–6]. Longer infant prophylaxis or maternal ARV resulted in reduced HIV transmission in these trials [7].…”

Section: Introductionmentioning

confidence: 99%

Frequent nevirapine resistance in infants infected by HIV-1 via breastfeeding while on nevirapine prophylaxis

Nelson

Fokar²,

Hudgens

et al. 2015

Aids

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Objective Assess nevirapine (NVP) resistance in infants who became infected in the three arms of the Breastfeeding, Antiretrovirals, and Nutrition (BAN) study: daily infant NVP prophylaxis, triple maternal antiretrovirals (ARV), or no extra intervention for 28 weeks of breastfeeding. Design Prospective cohort study. Methods The latest available plasma or dried blood spot specimen was tested from infants who became HIV-positive between 3 and 48 weeks of age. Population sequencing was used to detect mutations associated with reverse transcriptase inhibitor resistance. Sequences were obtained from 22/25 transmissions in the infant-NVP arm, 23/30 transmissions in the maternal-ARV arm, and 33/38 transmissions in the control arm. Results HIV-infected infants in the infant-NVP arm were significantly more likely to have NVP resistance than infected infants in the other two arms of the trial, especially during breastfeeding through 28 weeks of age (56% in infant-NVP arm vs. 6% in maternal-ARV arm and 11% in control arm, p=0.004). There was a nonsignificant trend suggesting infants with NVP resistance tended to be infected earlier and exposed to NVP while infected for a greater duration than infants without resistance. Conclusions Infants on NVP prophylaxis during breastfeeding are at reduced risk of acquiring HIV, but are at increased risk of NVP resistance if they do become infected. These findings point to the need for frequent HIV testing of infants while on NVP prophylaxis, and for availability of antiretroviral regimens excluding NVP for treating infants who become infected while on such a prophylactic regimen.

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HIV transmission and 24-month survival in a randomized trial of HAART to prevent MTCT during pregnancy and breastfeeding in Botswana

Cited by 43 publications

References 21 publications

HIV‐free survival at 12–24 months in breastfed infants of HIV‐infected women on antiretroviral treatment

HIV‐free survival at 12–24 months in breastfed infants of HIV‐infected women on antiretroviral treatment

Under-five mortality according to maternal survival: a systematic review and meta-analysis

Frequent nevirapine resistance in infants infected by HIV-1 via breastfeeding while on nevirapine prophylaxis

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