Van Schalkwyk M., Andersson M.I., Zeier M.D., La Grange M., Taljaard J.J., Theron G.B.
Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
Van Schalkwyk, M., Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; Andersson, M.I., Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; Zeier, M.D., Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; La Grange, M., Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; Taljaard, J.J., Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; Theron, G.B., Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
Background: In April 2010, revised Prevention of Mother-to-Child Transmission guidelines were implemented in South Africa, advising fast-tracked lifelong highly active antiretroviral therapy (HAART) initiation at a higher CD4 count (#350 cells per microliter). This study describes the impact of these changes on the management of pregnant women who initiated HAART at Tygerberg Hospital, Cape Town. Methods: We conducted a retrospective review of all women who initiated HAART in pregnancy at the Tygerberg Hospital between January 2008 and December 2010. Year cohorts were compared. Results: Two hundred and fifty HIV-infected women were included in the study and stratified by HAART initiation year: 2008:N = 82, 2009: N = 71, 2010:N = 97. There were no differences between the groups in age or parity. Median booking CD4 count was 155 cells per microliter [interquartile range (IQR) 107-187], 157 cells per microliter (IQR 104- 206) and 208 cells per microliter (IQR 138-270), respectively (P , 0.001). Median gestation at HAART initiation was 31 weeks (IQR 27-35), 30 weeks (IQR 26-34), and 25 weeks (IQR 21-31; P , 0.001). HIV transmission rates were 3/65 (4.6%), 4/57 (7.0%), and 0/ 90 (0.0%; P = 0.021). Women ,8 weeks on HAART before delivery were more likely to transmit than women $8 weeks [odds ratio 9.69; 95% confidence interval 1.66 to 56.58; P = 0.017]. Ninety-four (37.6%) women were lost to follow-up, 18.4% within 28 days of delivery. Conclusions: The positive impact of the new Prevention of Mother-to-Child Transmission program is evident. A longer duration of HAART before delivery was associated with less transmission. However, the lost to follow-up rates remain concerning. Further research is needed to better understand the reasons for nonadherence and mechanisms to improve support for these women. Copyright © 2013 by Lippincott Williams & Wilkins.
adult; article; CD4 lymphocyte count; female; follow up; highly active antiretroviral therapy; human; Human immunodeficiency virus; major clinical study; organization and management; practice guideline; pregnancy; pregnant woman; priority journal; retrospective study; South Africa; disease transmission; Human immunodeficiency virus infection; outpatient department; patient compliance; practice guideline; pregnancy complication; vertical transmission; anti human immunodeficiency virus agent; Adult; Ambulatory Care Facilities; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; CD4 Lymphocyte Count; Female; Guidelines as Topic; HIV Infections; Humans; Infectious Disease Transmission, Vertical; Lost to Follow-Up; Patient Compliance; Pregnancy; Pregnancy Complications, Infectious; Retrospective Studies; South Africa