WHO 2010 guidelines for prevention of mother-to-child HIV transmission in Zimbabwe: modeling clinical outcomes in infants and mothers
Ciaranello, A.L.; Perez, F.; Maruva, M.; Chu, J.; Engelsmann, B.; Keatinge, J.; Walensky, R.P.; Mushavi, A.; Mugwagwa, R.; Dabis, F.; Freedberg, K.A.; Danel, C.; N'Dri-Yoman, Térèse.; Messou, Eène.; Moh, R.; Ouattara, E.; Seyler, C.; Touré, S.; Yazdanpanah, Y.; Anglaret, X.; Gabillard, D.; Touré, H.; Kumarasamy, N.; Ganesh, A.K.; Martinson, N.; Mohapi, L.; Cotich, K.; Goldie, S.J.; Kimmel, A.D.; Lipsitch, M.; McCormick, A.; Rydzak, C.; Seage, G.R.; Weinstein, M.C.; Horsburgh, C.Robert.
Plos one 6(6): E20224
2011
ISSN/ISBN: 1932-6203 PMID: 21655097 DOI: 10.1371/journal.pone.0020224Document Number: 225960
The Zimbabwean national prevention of mother-to-child HIV transmission (PMTCT) program provided primarily single-dose nevirapine (sdNVP) from 2002-2009 and is currently replacing sdNVP with more effective antiretroviral (ARV) regimens. Published HIV and PMTCT models, with local trial and programmatic data, were used to simulate a cohort of HIV-infected, pregnant/breastfeeding women in Zimbabwe (mean age 24.0 years, mean CD4 451 cells/µL). We compared five PMTCT regimens at a fixed level of PMTCT medication uptake: 1) no antenatal ARVs (comparator); 2) sdNVP; 3) WHO 2010 guidelines using "Option A" (zidovudine during pregnancy/infant NVP during breastfeeding for women without advanced HIV disease; lifelong 3-drug antiretroviral therapy (ART) for women with advanced disease); 4) WHO "Option B" (ART during pregnancy/breastfeeding without advanced disease; lifelong ART with advanced disease); and 5) "Option B+:" lifelong ART for all pregnant/breastfeeding, HIV-infected women. Pediatric (4-6 week and 18-month infection risk, 2-year survival) and maternal (2- and 5-year survival, life expectancy from delivery) outcomes were projected. Eighteen-month pediatric infection risks ranged from 25.8% (no antenatal ARVs) to 10.9% (Options B/B+). Although maternal short-term outcomes (2- and 5-year survival) varied only slightly by regimen, maternal life expectancy was reduced after receipt of sdNVP (13.8 years) or Option B (13.9 years) compared to no antenatal ARVs (14.0 years), Option A (14.0 years), or Option B+ (14.5 years). Replacement of sdNVP with currently recommended regimens for PMTCT (WHO Options A, B, or B+) is necessary to reduce infant HIV infection risk in Zimbabwe. The planned transition to Option A may also improve both pediatric and maternal outcomes.