Impact of Antiretroviral Drugs in Pregnant Women and Their Children in Africa: HIV Resistance and Treatment Outcomes

Impact of Antiretroviral Drugs in Pregnant Women and Their Children in Africa: HIV Resistance and Treatment Outcomes

Online publication: 02/06/2013

Abstract:

 The global community has committed itself to eliminating new pediatric HIV infections by 2015 and improving maternal, newborn, and child health and survival in the context of HIV. Such objectives require regimens to prevent mother-to-child transmission (pMTCT) which, while being highly efficacious, protect the efficacy of future first-line antiretroviral therapy (ART). Major obstacles to eliminating vertical transmissions globally include low rates of adherence to ART and non-completion of the 'pMTCT cascade' due to programmatic and structural challenges faced by healthcare systems in low-income countries. Providing all pregnant women with lifelong ART regardless of CD4 count/disease stage (Option B+) could be the most effective option to prevent both HIV transmission and resistance, assuming adherence is successfully maintained. This strategy is more likely to achieve sustained undetectable HIV viremia, does not involve ART interruptions, is simpler to implement, and is cost-effective. Where Option B+ is not available, options A (short course zidovudine with single-dose nevirapine and an ARV "tail") and B (combination ART during pregnancy and breastfeeding, with ART cessation after weaning in women not qualifying for ART for their own health) are also efficacious, highly cost-effective and associated with infrequent resistance selection if taken properly. Read abstract online in The Journal of Infectious Diseases

Authors: Roger Paredes1,2,3, Vincent C. Marconi4,5,6, Shahin Lockman7,8,9, Elaine J. Abrams10,11 and Louise Kuhn10,12 1IrsiCaixa AIDS Research Institute 2HIV Unit, Internal Medicine Department, Hospital Universitari Germans Trias i Pujol 3Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain 4Division of Infectious Diseases, Emory University School of Medicine 5Department of Global Health, Rollins School of Public Health, Emory University 6Atlanta Veterans Affairs Medical Center, Atlanta, Georgia 7Brigham and Women's Hospital 8Harvard School of Public Health, Boston, Massachusetts 9Botswana Harvard School of Public Health AIDS Initiative Partnership, Gaborone, Botswana 10Department of Epidemiology, Mailman School of Public Health, Columbia University 11Department of Pediatrics, College of Physicians & Surgeons, Columbia University 12Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York
  • Doi Code: doi: 10.1093/infdis/jit110

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