Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

Maternal Highly Active Antiretroviral Therapy and Child HIV-Free Survival in Malawi, 2004-2009

TitleMaternal Highly Active Antiretroviral Therapy and Child HIV-Free Survival in Malawi, 2004-2009
Publication TypeJournal Article
Year of Publication2016
AuthorsSchwartz, SR, Kumwenda, N, Kumwenda, J, Chen, S, Mofenson, LM, Taylor, AW, Fowler, MG, Taha, TE
JournalMatern Child Health J
Date PublishedMar
ISBN Number1092-7875
Accession Number26525557
KeywordsBreastfeeding, Child survival, highly active antiretroviral therapy, HIV-1, Prevention of mother-to-child transmission

Objectives Highly active antiretroviral therapy (HAART) provision to eligible HIV-infected pregnant and post-partum women is critical for optimizing maternal health. We assessed the impact of maternal HAART on HIV-free survival of breastfed infants in Malawi. Methods The post-exposure prophylaxis of infants-Malawi trial (2004-2009) enrolled mothers/infants during labor or immediately post-partum to evaluate 14-week extended infant antiretroviral prophylaxis for preventing HIV transmission through breastfeeding. Mothers meeting national HAART guidelines were referred for therapy. Child HIV-free survival-survival without HIV infection-was compared by maternal HAART status. Results Overall, 3022 mother-infant pairs contributed 4214 infant/person-years (PY) at-risk for HIV infection or death, with 532 events (incidence 12.6/100 PY, 95 % confidence interval [CI] 11.6-13.7). During follow-up, 349 mothers were HAART initiated; 581 remained HAART naive with CD4 cell counts <250 cells/mm(3), and 2092 were never HAART-eligible. By 3 months, 11 % of infants with HAART naive mothers (CD4 < 250) were infected with HIV or died versus 7 % of infants of HAART-initiated mothers and 4 % of infants of HAART-ineligible mothers. Maternal HAART was associated with a 46 % reduction in infant HIV infection or death as compared to infants with HAART naive mothers (CD4 < 250) (adjusted hazards ratio 0.54, 95 % CI 0.36-0.81). Among HIV-exposed, uninfected infants, breastfeeding, but not HAART, was significantly associated with decreased child mortality. Conclusions HIV infection and mortality are high during the first 3 months post-partum in infants of mothers with advanced HIV, and rapid maternal HAART initiation can significantly improve HIV-related infant outcomes. Clinical Trials Registration This study is registered at under trial number NCT00115648.