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Effects of Highly Active Antiretroviral Therapy Duration and Regimen on Risk for Mother-to-Child Transmission of HIV in Johannesburg, South Africa

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Abstract
Background: Limited information exists about effects of different highly active antiretroviral therapy (HAART) regimens and duration of regimens on mother-to-child transmission (MTCT) of HIV among women in Africa who start treatment for advanced immunosuppression. Methods: Between January 2004 to August 2008, 1142 women were followed at antenatal antiretroviral clinics in Johannesburg. Predictors of MTCT (positive infant HIV DNA polymerase chain reaction at 4-6 weeks) were assessed with multivariate logistic regression. Results: Mean age was 30.2 years (SD = 5.0) and median baseline CD4 count was 161 cells per cubic millimeter (SD = 84.3). HAART duration at time of delivery was a mean 10.7 weeks (SD = 7.4) for the 85% of women who initiated treatment during pregnancy and 93.4 weeks (SD = 37.7) for those who became pregnant on HAART. Overall MTCT rate was 4.9% (43 of 874), with no differences detected between HAART regimens. MTCT rates were lower in women who became pregnant on HAART than those initiating HAART during pregnancy (0.7% versus 5.7%; P = 0.01). In the latter group, each additional week of treatment reduced odds of transmission by 8% (95% confidence interval: 0.87 to 0.99, P = 0.02). Conclusions: Late initiation of HAART is associated with increased risk of MTCT. Strategies are needed to facilitate earlier identification of HIV-infected women.
Keywords
CIGARETTE-SMOKING, PREMATURE RUPTURE, RANDOMIZED-TRIAL, SINGLE-DOSE NEVIRAPINE, HUMAN-IMMUNODEFICIENCY-VIRUS, FRENCH PERINATAL COHORT, PREGNANT-WOMEN, RUPTURED MEMBRANES, HIV-1-INFECTED WOMEN, VERTICAL TRANSMISSION

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Chicago
Hoffman, Risa M, Vivian Black, Karl Technau, Karin Joan van der Merwe, Judith Currier, Ashraf Coovadia, and Matthew Chersich. 2010. “Effects of Highly Active Antiretroviral Therapy Duration and Regimen on Risk for Mother-to-Child Transmission of HIV in Johannesburg, South Africa.” Jaids-journal of Acquired Immune Deficiency Syndromes 54 (1): 35–41.
APA
Hoffman, R. M., Black, V., Technau, K., van der Merwe, K. J., Currier, J., Coovadia, A., & Chersich, M. (2010). Effects of Highly Active Antiretroviral Therapy Duration and Regimen on Risk for Mother-to-Child Transmission of HIV in Johannesburg, South Africa. JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, 54(1), 35–41.
Vancouver
1.
Hoffman RM, Black V, Technau K, van der Merwe KJ, Currier J, Coovadia A, et al. Effects of Highly Active Antiretroviral Therapy Duration and Regimen on Risk for Mother-to-Child Transmission of HIV in Johannesburg, South Africa. JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS; 2010;54(1):35–41.
MLA
Hoffman, Risa M, Vivian Black, Karl Technau, et al. “Effects of Highly Active Antiretroviral Therapy Duration and Regimen on Risk for Mother-to-Child Transmission of HIV in Johannesburg, South Africa.” JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES 54.1 (2010): 35–41. Print.
@article{980749,
  abstract     = {Background: Limited information exists about effects of different highly active antiretroviral therapy (HAART) regimens and duration of regimens on mother-to-child transmission (MTCT) of HIV among women in Africa who start treatment for advanced immunosuppression.
Methods: Between January 2004 to August 2008, 1142 women were followed at antenatal antiretroviral clinics in Johannesburg. Predictors of MTCT (positive infant HIV DNA polymerase chain reaction at 4-6 weeks) were assessed with multivariate logistic regression.

Results: Mean age was 30.2 years (SD = 5.0) and median baseline CD4 count was 161 cells per cubic millimeter (SD = 84.3). HAART duration at time of delivery was a mean 10.7 weeks (SD = 7.4) for the 85\% of women who initiated treatment during pregnancy and 93.4 weeks (SD = 37.7) for those who became pregnant on HAART. Overall MTCT rate was 4.9\% (43 of 874), with no differences detected between HAART regimens. MTCT rates were lower in women who became pregnant on HAART than those initiating HAART during pregnancy (0.7\% versus 5.7\%; P = 0.01). In the latter group, each additional week of treatment reduced odds of transmission by 8\% (95\% confidence interval: 0.87 to 0.99, P = 0.02).

Conclusions: Late initiation of HAART is associated with increased risk of MTCT. Strategies are needed to facilitate earlier identification of HIV-infected women.},
  author       = {Hoffman, Risa M and Black, Vivian and Technau, Karl and van der Merwe, Karin Joan and Currier, Judith and Coovadia, Ashraf and Chersich, Matthew},
  issn         = {1525-4135},
  journal      = {JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES},
  keyword      = {CIGARETTE-SMOKING,PREMATURE RUPTURE,RANDOMIZED-TRIAL,SINGLE-DOSE NEVIRAPINE,HUMAN-IMMUNODEFICIENCY-VIRUS,FRENCH PERINATAL COHORT,PREGNANT-WOMEN,RUPTURED MEMBRANES,HIV-1-INFECTED WOMEN,VERTICAL TRANSMISSION},
  language     = {eng},
  number       = {1},
  pages        = {35--41},
  publisher    = {LIPPINCOTT WILLIAMS \& WILKINS},
  title        = {Effects of Highly Active Antiretroviral Therapy Duration and Regimen on Risk for Mother-to-Child Transmission of HIV in Johannesburg, South Africa},
  url          = {http://dx.doi.org/10.1097/QAI.0b013e3181cf9979},
  volume       = {54},
  year         = {2010},
}

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