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Reduction of maternal mortality with highly active antiretroviral therapy in a large cohort of HIV-infected pregnant women in Malawi and Mozambique.
- Source :
-
PloS one [PLoS One] 2013 Aug 19; Vol. 8 (8), pp. e71653. Date of Electronic Publication: 2013 Aug 19 (Print Publication: 2013). - Publication Year :
- 2013
-
Abstract
- Background: HIV infection is a major contributor to maternal mortality in resource-limited settings. The Drug Resource Enhancement Against AIDS and Malnutrition Programme has been promoting HAART use during pregnancy and postpartum for Prevention-of-mother-to-child-HIV transmission (PMTCT) irrespective of maternal CD4 cell counts since 2002.<br />Methods: Records for all HIV+ pregnancies followed in Mozambique and Malawi from 6/2002 to 6/2010 were reviewed. The cohort was comprised by pregnancies where women were referred for PMTCT and started HAART during prenatal care (n = 8172, group 1) and pregnancies where women were referred on established HAART (n = 1978, group 2).<br />Results: 10,150 pregnancies were followed. Median (IQR) baseline values were age 26 years (IQR:23-30), CD4 count 392 cells/mm(3) (IQR:258-563), Viral Load log10 3.9 (IQR:3.2-4.4), BMI 23.4 (IQR:21.5-25.7), Hemoglobin 10.0 (IQR: 9.0-11.0). 101 maternal deaths (0.99%) occurred during pregnancy to 6 weeks postpartum: 87 (1.1%) in group 1 and 14 (0.7%) in group 2. Mortality was 1.3% in women with <than 350 CD4 cells/mm(3) and 0.7% in women with greater than 350 CD4s cells/mm(3) [OR = 1.9 (CL 1.3-2.9) p = 0.001]. Mortality was higher in patients with shorter antenatal HAART: 22/991 (2.2%) if less than 30 days and 79/9159 (0.9%) if 31 days or greater [OR = 2.6 (CL 1.6-4.2) p<0.001]. By multivariate analysis, shorter antenatal HAART (p<0.001), baseline values for CD4 cell count (p = 0.012), hemoglobin (p = 0.02), and BMI (p<0.001) were associated with mortality. Four years later, survival was 92% for women with shorter antenatal HAART and 98% for women on established therapy prior to pregnancy, p = 0.001.<br />Conclusions: Antiretrovirals for PMTCT purposes have significant impact on maternal mortality as do CD4 counts and nutritional status. In resource-limited settings, PMTCT programs should provide universal HAART to all HIV+ pregnant women given its impact in prevention of maternal death.
- Subjects :
- Adult
CD4 Lymphocyte Count
Female
Follow-Up Studies
HIV Infections mortality
HIV Infections transmission
Humans
Kaplan-Meier Estimate
Malawi
Maternal Mortality
Mozambique
Multivariate Analysis
Outcome Assessment, Health Care statistics & numerical data
Pregnancy
Pregnancy Complications, Infectious mortality
Pregnancy Complications, Infectious virology
Proportional Hazards Models
Retrospective Studies
Survival Rate
Young Adult
Antiretroviral Therapy, Highly Active
HIV Infections drug therapy
Infectious Disease Transmission, Vertical prevention & control
Pregnancy Complications, Infectious drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1932-6203
- Volume :
- 8
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- PloS one
- Publication Type :
- Academic Journal
- Accession number :
- 23990966
- Full Text :
- https://doi.org/10.1371/journal.pone.0071653