Trends in the management and outcomes of HIV-infected women and their infants at sites in Latin America and the Caribbean: 2002-2009
J. Read1, G. Duarte2, L. Freimanis Hance3, J. Pinto4, M. Gouvea5, B. Santos6, E. Telles7, R. Succi8, J. Alarcon9, S. Stoszek3
1National Institutes of Health, Bethesda, United States, 2Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil, 3Westat, Rockville, United States, 4Universidade Federal de Minas Gerais, Belo Horizonte, Brazil, 5Hospital dos Servidores do Estado-Saude, Rio de Janeiro, Brazil, 6Hospital Conceicao, Porto Alegre, Brazil, 7Hospital Femina, Porto Alegre, Brazil, 8Federal University of Sao Paulo, Sao Paulo, Brazil, 9University of San Marcos, Lima, Peru
Background: The NISDI Perinatal Protocol enrolled HIV-infected pregnant women and their infants at sites in Argentina, the Bahamas, Brazil, Jamaica, Mexico, and Peru from 2002-2007. A revised protocol (LILAC) enrolled in 2008-2009. We describe temporal trends in the management and outcomes of these HIV-infected women and their infants.
Methods: Women were enrolled during pregnancy and followed for ≥ 6 months in both protocols. The study population comprised first on-study pregnancies for women with singleton live births with available data. Variables were compared by year of enrollment grouped in 2-year periods from 2002-2009. P-values were calculated using the chi-square test.
Results: Of 1569 enrolled women, 1344 met inclusion criteria. 1119 women (83%) and 1112 infants (83%) completed follow-up through 6 months after delivery/birth. Over time, more women had initial viral loads (VLs) (copies/mL) < 1000 (e.g., 51% in 2002-03 vs. 64% in 2008-09; p=0.0055) and CD4 counts (cells/mm3) >500 cells/mm3 (e.g., 32% in 2002-03 vs. 46% in 2008-09; p=0.0091). Additionally, more women had VL < 1000 after delivery (p=0.03). There was an increase in the use of 3-drug and PI-based regimens as the most complex ARV regimen during pregnancy (p< 0.0001). Neither mode of delivery (34% cesarean before labor/before ruptured membranes) nor infant low birth weight (14%) changed significantly over time. 99% of infants received ARV prophylaxis within 7 days after birth. Breastfeeding was reported for less than 1% of infants. The rate of mother-to-child transmission (MTCT) of HIV did not change significantly over time (overall = 1.0%).
Conclusions: Over time, the initial VL and CD4 indices improved, possibly reflecting greater access to ARVs and/or use of more potent regimens. There were temporal trends in the types of ARV regimens used during pregnancy. Maternal outcomes improved over time (more women with VL < 1000 after delivery), and the MTCT rate was very low.
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