Maternal Highly Active Antiretroviral Therapy and Child HIV-Free Survival in Malawi, 2004–2009

Abstract

Objectives Highly active antiretroviral therapy (HAART) provision to eligible HIV-infected pregnant and post-partum women is critical for optimizing maternal health. We assessed the impact of maternal HAART on HIV-free survival of breastfed infants in Malawi. Methods The Post-Exposure Prophylaxis of Infants (PEPI)-Malawi trial (2004-2009) enrolled mothers/infants during labor or immediately post-partum to evaluate 14-week extended infant antiretroviral prophylaxis for preventing HIV transmission through breastfeeding. Mothers meeting national HAART guidelines were referred for therapy. Child HIV-free survival--survival without HIV infection --was compared by maternal HAART status. Results Overall, 3,022 mother-infant pairs contributed 4,214 infant/person-years (PY) at-risk for HIV infection or death, with 532 events (incidence 12.6/100 PY, 95% confidence interval [CI] 11.6-13.7). During follow-up, 349 mothers were HAART initiated; 581 remained HAART naïve with CD4 cell counts <250 cells/mm3, and 2,092 were never HAART-eligible. By three months, 11% of infants with HAART naïve mothers (CD4<250) were infected with HIV or died versus 7% of infants of HAART-initiated mothers and 4% of infants of HAART-ineligible mothers. Maternal HAART was associated with a 46% reduction in infant HIV infection or death as compared to infants with HAART naïve mothers (CD4<250) (adjusted Hazards Ratio: 0.54,95% CI 0.36-0.81). Among HIV-exposed, uninfected infants, breastfeeding, but not HAART, was significantly associated with decreased child mortality. Conclusions HIV infection and mortality are high during the first 3 months post-partum in infants of mothers with advanced HIV, and rapid maternal HAART initiation can significantly improve HIV-related infant outcomes.

Factors associated with the practice of exclusive breastfeeding for six months among mothers on antiretroviral therapy in the Eastern Cape, South Africa

“…In this study, the prevalence of six-month EBF was low (32.0%), which falls far below the WHO recommendation of 90% coverage [32]. However, the EBF rate obtained in this study is comparable to the EBF rates of 31.6% among infants aged under six months [33]. Generally, the low prevalence rates of EBF in South…”

Sociodemographic and lifestyle correlates of exclusive breastfeeding practices among mothers on antiretroviral therapy in the Eastern Cape, South Africa

“…However, direct comparison of EBF prevalence in this study with many other studies on EBF practice is a difficult task, given the variations in the definitions of EBF in different studies, the timing, duration of recall, methods of analysis, and sample biases [32]. Notwithstanding, the EBF prevalence obtained in this study is comparable to 31.6% among infants exclusively breastfeed for the first 6 months after delivery in Malawi, which was measured by recall method [33].…”

Sociodemographic and lifestyle correlates of exclusive breastfeeding practices among mothers on antiretroviral therapy in the Eastern Cape, South Africa

“…However, direct comparison of EBF prevalence in this study with many other studies on EBF practice is a di cult task, given the variations in the de nitions of EBF in different studies, the timing, duration of recall, methods of analysis and sample biases [32]. Notwithstanding, the EBF prevalence obtained in this study is comparable to 31.6% among infants aged under six months in Malawi [33].…”