Evaluation of 4 weeks' neonatal antiretroviral prophylaxis as a component of a prevention of mother-to-child transmission program in a resource-rich setting.
Affiliation
Department of Pediatric Infectious Diseases, Our Lady's Children's Hospital, Dublin, Ireland. wferguson@rotunda.ieIssue Date
2011-05MeSH
Anti-Retroviral AgentsChemoprevention
Female
HIV
HIV Infections
Humans
Infant, Newborn
Infectious Disease Transmission, Vertical
Ireland
Male
Polymerase Chain Reaction
Pregnancy
Pregnancy Complications, Infectious
Treatment Outcome
Metadata
Show full item recordCitation
Evaluation of 4 weeks' neonatal antiretroviral prophylaxis as a component of a prevention of mother-to-child transmission program in a resource-rich setting. 2011, 30 (5):408-12 Pediatr. Infect. Dis. J.Journal
The Pediatric infectious disease journalDOI
10.1097/INF.0b013e31820614bdPubMed ID
21266939Additional Links
http://www.ncbi.nlm.nih.gov/pubmed/21266939Abstract
In resource-rich settings, universal adoption of a 4- rather than 6-week neonatal antiretroviral (ARV) prophylaxis regimen could reduce toxicity and results in cost savings, provided prevention of mother-to-child transmission program effectiveness is not compromised.Between January 1999 and December 2008, a 10-year study of the observational database of the Irish prevention of mother-to-child transmission program that uses a 4- rather than 6-week neonatal ARV prophylaxis regimen was undertaken. Maternal and infant data were analyzed to determine the vertical transmission rate (VTR) and infant outcome. Infants were categorized as uninfected if, off ARVs, they had 2 negative human immunodeficiency virus (HIV) polymerase chain reaction (PCR) tests, the second at 3 months of age or older.
Between January 1999 and December 2008, there were 964 HIV-exposed live births. Excluding 7 early neonatal deaths, 4 weeks of ARV prophylaxis was prescribed for 957 infants: 61% received mono, 32% triple, and 7% dual therapy. Of 957 infants, 906 were uninfected, 10 infected, and 41 of indeterminate status. Twenty-four of the indeterminate status infants had at least one negative HIV PCR test at ≥ 6 weeks and 17 were lost to follow-up before 6 weeks of age. On the basis of 916 infants of known outcome, the VTR was 1.09% (95% confidence interval, 1.07-1.11). If restricted to 910 infants whose mothers received at least 4 weeks of antiretroviral therapy (ART), the VTR was 0.4%.
This study provides evidence to support the current clinical practice toward use of a 4-week neonatal ARV prophylaxis regimen.
Item Type
ArticleLanguage
enISSN
1532-0987ae974a485f413a2113503eed53cd6c53
10.1097/INF.0b013e31820614bd