Improving Outcomes in Infants of HIV-Infected Women in a Developing Country Setting

Since 1999 GHESKIO, a large voluntary counseling and HIV testing center in Port-au-Prince, Haiti, has had an ongoing collaboration with the Haitian Ministry of Health to reduce the rate of mother to child HIV transmission. There are limited data on the ability to administer complex regimens for reducing mother to child transmission and on risk factors for continued transmission and infant mortality within programmatic settings in developing countries.We analyzed data from 551 infants born to HIV-infected mothers seen at GHESKIO, between 1999 and 2005. HIV-infected mothers and their infants were given "short-course" monotherapy with antiretrovirals for prophylaxis; and, since 2003, highly active antiretroviral therapy (HAART) when clinical or laboratory indications were met. Infected women seen in the pre-treatment era had 27% transmission rates, falling to 10% in this cohort of 551 infants, and to only 1.9% in infants of women on HAART. Mortality rate after HAART introduction (0.12 per year of follow-up [0.08-0.16]) was significantly lower than the period before the availability of such therapy (0.23 [0.16-0.30], P<0.0001). The effects of maternal health, infant feeding, completeness of prophylaxis, and birth weight on mortality and transmission were determined using univariate and multivariate analysis. Infant HIV-1 infection and low birth weight were associated with infant mortality in less than 15 month olds in multivariate analysis.Our findings demonstrate success in prevention of mother-to-child HIV transmission and mortality in a highly resource constrained setting. Elements contributing to programmatic success include provision of HAART in the context of a comprehensive program with pre and postnatal care for both mother and infant

Cohort comparison before and after the introduction of HAART prophylaxis.

*<p>Unless otherwise indicated, data are presented as number (%)</p>+<p>Number for whom data was available</p>#<p>Difference between Pre-HAART and Post-HAART cohort using: ¹ Pearson's chi-square test;² Wilcoxon Test</p

Profile of Cohort.

<p>Population used to estimate rate of mother-to-child transmission of HIV in the GHESKIO PMTCT program in Port-au-Prince, Haiti between March 1999 through December 2005. Cohort is divided based on the date of initiation of HAART for both individual health and PMTCT. Among the 47 HIV-infected infants, 38 had received scZDV alone, eight had received no-prophylaxis and 1 had received HAART.</p

Risk factors associated with infant <b>mortality</b>

*<p>Continuous variables (⁺) represented as median value (lower quartile-upper quartile), all others as frequencies (%, by row).</p>1<p>Pearson's chi-square test unless otherwise indicated; ² Wilcoxon Test</p

Risk factors associated with <b>transmission</b> of HIV-1 from mother to infant.

*<p>Continuous variables (⁺) represented as median value (IQR), all others as frequencies (%, calculated by row.</p>a<p>Sixty received HAART, eight received sd-NEV, rest received monotherapy with AZT.</p>1<p>Pearson's chi-square test; ² Kruskal-Wallis test</p

Univariate analysis comparing early and late infant <b>mortality</b>

*<p>Continuous variables (⁺) represented as median value (lower quartile-upper quartile), all others as frequencies (%, by row).</p>1<p>Pearson's chi-square test unless otherwise indicated; ² Wilcoxon Test</p