<scp>HIV</scp> viraemia and mother‐to‐child transmission risk after antiretroviral therapy initiation in pregnancy in Cape Town, South Africa

Myer, Landon; Phillips, Tamsin K; Ja, McIntyre; Ny, Hsiao; Petro, Gregory; Zerbe, Allison; Ramjith, Jordache; Bekker, Linda‐Gail; Ej, Abrams

doi:10.1111/hiv.12397

Cited by 101 publications

(106 citation statements)

References 19 publications

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“…To our knowledge, only one other study has reported on VL outcomes of a PMTCTB+ cohort in sub-Saharan Africa and reported similar findings [37]. VL monitoring was still quite a novel practice for health workers and its routine use for treatment monitoring was still not fully established [38].…”

Section: Discussionmentioning

confidence: 90%

Challenges and successes in the implementation of option B+ to prevent mother-to-child transmission of HIV in southern Swaziland

et al. 2018

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BackgroundUniversal antiretroviral therapy (ART) for all pregnant/ breastfeeding women living with Human Immunodeficiency Virus (HIV), known as Prevention of mother-to child transmission of HIV (PMTCT) Option B+ (PMTCTB+), is being scaled up in most countries in Sub-Saharan Africa. In the transition to PMTCTB+, many countries face challenges with proper implementation of the HIV care cascade. We aimed to describe the feasibility of a PMTCTB+ approach in the public health sector in Swaziland.MethodsLifelong ART was offered to a cohort of HIV+ pregnant women aged ≥16 years at the first antenatal care (ANC1) visit in 9 public sector facilities, between 01/2013 and 06/2014. The study enrolment period was divided into 3 phases (early: 01–06/2013, mid: 07–12/2013 and late: 01–06/2014) to account for temporal trends. Kaplan-Meier estimates and Cox proportional-hazards regression models were applied for ART initiation and attrition analyses.ResultsOf 665 HIV+ pregnant women, 496 (74.6%) initiated ART. ART initiation increased in later study enrolment phases (mid: aHR: 1.41; later: aHR: 2.36), and decreased at CD4 ≥ 500 (aHR: 0.69). 52.9% were retained in care at 24 months. Attrition was associated with ANC1 in the third trimester (aHR: 2.37), attending a secondary care facility (aHR: 1.98) and ART initiation during later enrolment phases (mid aHR: 1.48; late aHR: 1.67). Of 373 women eligible, 67.3% received a first VL. 223/251 (88.8%) were virologically suppressed (< 1000 copies/mL). Of 670 infants, 53.6% received an EID test, 320/359 had a test result recorded and of whom 7 (2.2%) were HIV+.ConclusionsPMTCTB+ was found to be feasible in this setting, with high rates of maternal viral suppression and low transmission to the infant. High treatment attrition, poor follow-up of mother-baby pairs and under-utilisation of VL and EID testing are important programmatic challenges.

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Section: Discussionmentioning

confidence: 90%

Challenges and successes in the implementation of option B+ to prevent mother-to-child transmission of HIV in southern Swaziland

et al. 2018

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“…17 In a study of over 1000 women starting Option B+ in public clinics in Malawi, 81% of women tested had HIV RNA <1000 copies/ml at 6 months after ART initiation, but 35% of women had no viral load testing performed. In a cohort of women who initiated ART during pregnancy in a study at a public clinic in Cape Town, South Africa in which viral loads were assessed routinely, 91% achieved viral suppression to <1000 copies/ml by delivery, 18 but only 70% maintained viral suppression to 12 month postpartum. 19 …”

Section: Discussionmentioning

confidence: 99%

Viral Suppression and Retention in Care up to 5 Years After Initiation of Lifelong ART During Pregnancy (Option B+) in Rural Uganda

Koss

Natureeba

Kwarisiima

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Women experiencing acute HIV infection, especially late in pregnancy and/or during the breastfeeding period, are most likely to transmit infection to their babies (3). Even when mothers are diagnosed with HIV and started on ART during the breastfeeding period, the risk of MTCT remains high due to poor maternal adherence (4)(5)(6). Thus, in 2015, ϳ150,000 infants (ϳ400 infants per day) became newly infected with HIV, half by breastfeeding (7,8).…”

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confidence: 99%

Impact of Poxvirus Vector Priming, Protein Coadministration, and Vaccine Intervals on HIV gp120 Vaccine-Elicited Antibody Magnitude and Function in Infant Macaques

Phillips

Fouda

Eudailey

et al. 2017

Clin Vaccine Immunol

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Despite success in reducing vertical HIV transmission by maternal antiretroviral therapy, several obstacles limit its efficacy during breastfeeding, and breast-milk transmission is now the dominant mode of mother-to-child transmission (MTCT) of HIV in infants. Thus, a pediatric vaccine is needed to eradicate oral HIV infections in newborns and infants. Utilizing the infant rhesus macaque model, we compared 3 different vaccine regimens: (i) HIV envelope (Env) protein only, (ii) poxvirus vector (modified vaccinia virus Ankara [MVA])-HIV Env prime and HIV Env boost, and (iii) coadministration of HIV Env and MVA-HIV Env at all time points. The vaccines were administered with an accelerated, 3-week-interval regimen starting at birth for early induction of highly functional HIV Env-specific antibodies. We also tested whether an extended, 6-week immunization interval using the same vaccine regimen as in the coadministration group would enhance the quality of antibody responses. We found that pediatric HIV vaccines administered at birth are effective in inducing HIV Env-specific plasma IgG. The vaccine regimen consisting of only HIV Env protein induced the highest levels of variable region 1 and 2 (V1V2)-specific antibodies and tier 1 neutralizing antibodies, whereas the extended-interval regimen induced both persistent Env-specific systemic IgG and mucosal IgA responses. Antibodydependent cell-mediated cytotoxicity (ADCC) antibodies in plasma were elicited by all vaccine regimens. These data suggest that infant immunizations beginning at birth are effective for the induction of functional HIV Env-specific antibodies that could potentially protect against breast milk transmission of HIV and set the stage for immunity prior to sexual debut.

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HIV viraemia and mother‐to‐child transmission risk after antiretroviral therapy initiation in pregnancy in Cape Town, South Africa

Cited by 101 publications

References 19 publications

Challenges and successes in the implementation of option B+ to prevent mother-to-child transmission of HIV in southern Swaziland

Challenges and successes in the implementation of option B+ to prevent mother-to-child transmission of HIV in southern Swaziland

Viral Suppression and Retention in Care up to 5 Years After Initiation of Lifelong ART During Pregnancy (Option B+) in Rural Uganda

Impact of Poxvirus Vector Priming, Protein Coadministration, and Vaccine Intervals on HIV gp120 Vaccine-Elicited Antibody Magnitude and Function in Infant Macaques

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