Rising mother-to-child HIV transmission in a resource-limited breastfeeding population

Gumbo, Felicity Zvanyadza; Kurewa, Nyaradzai Edith; Kandawasvika, Gwendoline Quintoline; Duri, Kerina; Mapingure, Munyaradzi; Munjoma, Marshal W; Pazvakavambwa, Isidore E.; Rusakaniko, Simbarashe; Chirenje, Mike; Stray‐Pedersen, Babill

doi:10.1258/td.2009.090167

Cited by 5 publications

(6 citation statements)

References 13 publications

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“…This coincides with the general decrease in HIV-1 prevalence in the general population and could be attributed to better access to antiretroviral prophylaxis. However, in this cohort receiving single dose nevirapine was not protective against HIV-1 vertical transmission [35]. This could possibly be due to a relatively small sample size.…”

Section: Discussionmentioning

confidence: 95%

Antenatal HIV-1 RNA load and timing of mother to child transmission; a nested case-control study in a resource poor setting

Duri

Gumbo

Kristiansen

et al. 2010

Virol J

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ObjectiveTo determine HIV-1 RNA load during the third trimester of pregnancy and evaluate its effect on in utero and intra-partum/postpartum transmissions in a breastfeeding population.DesignA nested case-control study within a PMTCT cohort of antiretroviral therapy naive pregnant women and their infants.MethodsA case was a mother who transmitted HIV-1 to her infant (transmitter) who was matched to one HIV-1 positive but non-transmitting mother (control).ResultsFrom a cohort of 691 pregnant women, 177 (25.6%) were HIV-1 positive at enrolment and from these 29 (23%) transmitted HIV-1 to their infants, 10 and 19 during in utero and intra-partum/postpartum respectively. Twenty-four mothers sero-converted after delivery and three transmitted HIV-1 to their infants. Each unit increase in log10 viral load was associated with a 178 cells/mm3 and 0.2 g/dL decrease in TLC and hemoglobin levels, p = 0.048 and 0.021 respectively, and a 29% increase in the risk of transmission, p = 0.023. Intra-partum/postpartum transmitters had significantly higher mean viral load relative to their matched controls, p = 0.034.ConclusionAntenatal serum HIV-1 RNA load, TLC and hemoglobin levels were significantly associated with vertical transmission but this association was independent of transmission time. This finding supports the rationale for preventive strategies designed to reduce vertical transmission by lowering maternal viral load.

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Section: Discussionmentioning

confidence: 95%

Antenatal HIV-1 RNA load and timing of mother to child transmission; a nested case-control study in a resource poor setting

Duri

Gumbo

Kristiansen

et al. 2010

Virol J

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“…This implies that they were given better counselling and early diagnosis and treatment of mastitis which are known risk factors of HIV transmission. 10, 12 It is of note (although not statistically significant) that HIV-infected children at a subsequent pregnancy had shorter exclusive breastfeeding periods – four months versus six months for the HIV-uninfected children – while the mean duration of breastfeeding was similar (10 months).…”

Section: Discussionmentioning

confidence: 92%

“…The proportion of HIV-infected infants was 21.8% (95% confidence interval [CI] −17.8–25.8) which has been previously reported. 10 …”

Section: Methodsmentioning

confidence: 99%

Reduced HIV transmission at subsequent pregnancy in a resource-poor setting

Gumbo

Kandawasvika²,

Duri³

et al. 2011

Trop Doct

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Several studies indicate that HIV-infected women continue to have children. We set out to determine the trend in HIV transmission at subsequent pregnancies. From 2002–2003, pregnant women were enrolled in a single dose nevirapine-based Prevention of Mother-to-Child Transmission of HIV (PMTCT) programme. Six years later, women with subsequent children in this cohort were identified and their children's HIV status determined. From 330 identified HIV-infected mothers, 73 had second/subsequent children with HIV results. Of these, nine (12.3%, 95% confidence interval [CI]: 4.6–20.1%) children were HIV-infected. Of the 73 second children, 51 had older siblings who had been initially enrolled in the study with definitive HIV results with an infection rate of 17/51 (33.3%, 95% CI: 19.9–46.7). About 35% of the women had been on antiretroviral drugs. These results demonstrate lower subsequent HIV transmission rates in women on a national PMTCT programme in a resource-poor setting with the advent of antiretroviral therapy.

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“…Other challenges in dealing with HIV mother-to-child transmission not addressed by the recent better regimens are breastfeeding transmission, mortality and transmission in subsequent children. [4][5][6] …”

Section: Akmentioning

confidence: 99%

“…First, routine antenatal HIV testing ('opt-out' approach) is now the standard of care for all pregnant women presenting for antenatal care in urban and rural Zimbabwe after pilot studies evaluating opt-out HIV testing found it feasible and acceptable with significant number of pregnant women accepting HIV testing with no adverse social consequences. 3,4 Second, more efficacious PMTCT regimens are currently being implemented in urban and rural antenatal clinics to enhance PMTCT effectiveness. Third, due to severe attrition of health-care workers and limited resources, implementation of PMTCT program using peer counselors and community mobilizers has proven very effective and similar strategies are currently implemented across other PMTCT programs in Zimbabwe.…”

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confidence: 99%