Reduction of maternal mortality with highly active antiretroviral therapy in a large cohort of HIV-infected pregnant women in Malawi and Mozambique

PloS One
Giuseppe LiottaMaria Cristina Marazzi

Abstract

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. 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). 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 th...Continue Reading

References

Aug 2, 2007·Obstetrics and Gynecology·Judette LouisUNKNOWN Maternal-Fetal Medicine Units Network, National Institute of Child Health and Human Development
Aug 2, 2008·Bulletin of the World Health Organization·Martin W G BrinkhofUNKNOWN ART-LINC, IeDEA
May 23, 2009·American Journal of Clinical Pathology·Marco VitoriaKevin M De Cock
Jan 15, 2010·International Journal of Gynaecology and Obstetrics : the Official Organ of the International Federation of Gynaecology and Obstetrics·John GrangeAlimuddin Zumla
Jun 24, 2010·Lancet·Quarraisha Abdool-KarimIsabelle de Zoysa
May 18, 2012·Journal of Pregnancy·Oliver EzechiJosaphat Byamugisha

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Citations

Dec 2, 2014·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Tamil KendallMary Nell Wegner
Oct 11, 2017·Expert Review of Clinical Pharmacology·Robert Pope, Angela Kashuba
Nov 28, 2017·Journal of the International AIDS Society·Coceka N MnyaniJames A McIntyre
Mar 27, 2020·Research and Practice in Thrombosis and Haemostasis·Lian LancasterAnnette von Drygalski
Nov 11, 2020·PloS One·Fausto CiccacciMaria Cristina Marazzi

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