WHO 2010 Guidelines for Prevention of Mother-to-Child HIV Transmission in Zimbabwe: Modeling Clinical Outcomes in Infants and Mothers
Open Access
- 2 June 2011
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 6 (6), e20224
- https://doi.org/10.1371/journal.pone.0020224
Abstract
The Zimbabwean national prevention of mother-to-child HIV transmission (PMTCT) program provided primarily single-dose nevirapine (sdNVP) from 2002–2009 and is currently replacing sdNVP with more effective antiretroviral (ARV) regimens. Published HIV and PMTCT models, with local trial and programmatic data, were used to simulate a cohort of HIV-infected, pregnant/breastfeeding women in Zimbabwe (mean age 24.0 years, mean CD4 451 cells/µL). We compared five PMTCT regimens at a fixed level of PMTCT medication uptake: 1) no antenatal ARVs (comparator); 2) sdNVP; 3) WHO 2010 guidelines using “Option A” (zidovudine during pregnancy/infant NVP during breastfeeding for women without advanced HIV disease; lifelong 3-drug antiretroviral therapy (ART) for women with advanced disease); 4) WHO “Option B” (ART during pregnancy/breastfeeding without advanced disease; lifelong ART with advanced disease); and 5) “Option B+:” lifelong ART for all pregnant/breastfeeding, HIV-infected women. Pediatric (4–6 week and 18-month infection risk, 2-year survival) and maternal (2- and 5-year survival, life expectancy from delivery) outcomes were projected. Eighteen-month pediatric infection risks ranged from 25.8% (no antenatal ARVs) to 10.9% (Options B/B+). Although maternal short-term outcomes (2- and 5-year survival) varied only slightly by regimen, maternal life expectancy was reduced after receipt of sdNVP (13.8 years) or Option B (13.9 years) compared to no antenatal ARVs (14.0 years), Option A (14.0 years), or Option B+ (14.5 years). Replacement of sdNVP with currently recommended regimens for PMTCT (WHO Options A, B, or B+) is necessary to reduce infant HIV infection risk in Zimbabwe. The planned transition to Option A may also improve both pediatric and maternal outcomes.Keywords
This publication has 71 references indexed in Scilit:
- First-line antiretroviral therapy after single-dose nevirapine exposure in South Africa: a cost-effectiveness analysis of the OCTANE trialAIDS, 2011
- Net survival of perinatally and postnatally HIV-infected children: a pooled analysis of individual data from sub-Saharan AfricaInternational Journal of Epidemiology, 2011
- Antiretroviral Therapies in Women after Single-Dose Nevirapine ExposureNew England Journal of Medicine, 2010
- Maternal or Infant Antiretroviral Drugs to Reduce HIV-1 TransmissionNew England Journal of Medicine, 2010
- Antiretroviral Regimens in Pregnancy and Breast-Feeding in BotswanaNew England Journal of Medicine, 2010
- Understanding Reasons for and Outcomes of Patients Lost to Follow-Up in Antiretroviral Therapy Programs in Africa Through a Sampling-Based ApproachJAIDS Journal of Acquired Immune Deficiency Syndromes, 2010
- Economic Value of Seasonal and Pandemic Influenza Vaccination during PregnancyClinical Infectious Diseases, 2009
- Mortality and Virologic Outcomes After Access to Antiretroviral Therapy Among a Cohort of HIV-Infected Women Who Received Single-Dose Nevirapine in Lusaka, ZambiaJAIDS Journal of Acquired Immune Deficiency Syndromes, 2009
- Persistent Minority K103N Mutations among Women Exposed to Single‐Dose Nevirapine and Virologic Response to Nonnucleoside Reverse‐Transcriptase Inhibitor–Based TherapyClinical Infectious Diseases, 2009
- Effects of Early, Abrupt Weaning on HIV-free Survival of Children in ZambiaNew England Journal of Medicine, 2008