AEGiS-15IAC: Mother to child HIV transmission prevention (MTCTP) in a managed care setting in South Africa - No role for short-term antiretroviral therapy (ART)?

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Mother to child HIV transmission prevention (MTCTP) in a managed care setting in South Africa - No role for short-term antiretroviral therapy (ART)?

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. ThOrB1351)

Hlatshwayo N, Hislop MS, Cotton M, Maartens G, Regensberg LD
Aid for AIDS (Pty)Ltd, Cape Town, South Africa

BACKGROUND: Aid for AIDS is a private sector HIV/AIDS disease management programme operating in Southern Africa. The objective of this study was to document experience with different MTCTP protocols in a managed healthcare setting.

METHODS: Data was from the confidential AfA database. Records were extracted for mothers who had received MTCTP. Selection criteria; (i) qualitative HIV PCR results available for neonates, (ii) adherence to ART confirmed by review of medical fund claims. MTCTP protocols were; monotherapy: AZT 250 mg bd for one month; dual therapy: AZT 300 mg + Lamivudine 150 mg bd for one month; HAART: 2 NRTI's + NNRTI or PI for at least 2 months prior to delivery. Caesarean section and formula feeds for six months after delivery were available to all mothers. Data was categorised by entry viral load and CD4 count. Statistical analysis was by the Fisher's exact test.

RESULTS: HIV PCR results were obtained on 1,298 neonates. Of these, 968, 128 and 131 received monotherapy, dual therapy or HAART. The respective HIV transmission rates were similar for mono (5.2%), and dual therapy (6.3%), but tended to be lower for HAART (1.5%) (mono vs dual p = 0.53, mono vs HAART, p = 0.08, dual vs HAART, p = 0.06). One month HAART was received by 71 mothers, with a transmission rate of 5.6%. The Caesarean section rate was >84%. For monotherapy with entry viral load ≤< log 4, transmission rate was 4.1%. Ten (24%) transmitting mothers on monotherapy had CD4 counts >500 cells/muL. Conclusion HIV transmission was not reduced using dual therapy, or< 1 month HAART, compared to monotherapy. However, transmission was reduced using >1 month HAART. Although entry viral load is predictive of transmission probability with use of mono therapy but not HAART, transmission still occurred with viral load ≤ 4 log, and CD4 >500, arguing against the use of monotherapy for MTCTP in this setting. Our data support the use of HAART for a minimum of 2 months for effective MTCTP.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, Viral Load, Zidovudine, HIV Infections, Anti-HIV Agents, HIV-1, HIV, HIV Protease Inhibitors, Mothers, HIV Seropositivity, South Africa, Africa, Southern, Child, Humans, transmission, therapy, prevention & control, drug therapy

040711
ThOrB1351