PLoS ONE (Jan 2013)

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

  • Giuseppe Liotta,
  • Sandro Mancinelli,
  • Karin Nielsen-Saines,
  • Elisabetta Gennaro,
  • Paola Scarcella,
  • Nurja Abdul Magid,
  • Paola Germano,
  • Haswell Jere,
  • Giovanni Guidotti,
  • Ersilia Buonomo,
  • Fausto Ciccacci,
  • Leonardo Palombi,
  • Maria Cristina Marazzi

DOI
https://doi.org/10.1371/journal.pone.0071653
Journal volume & issue
Vol. 8, no. 8
p. e71653

Abstract

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BackgroundHIV 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.MethodsRecords 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).Results10,150 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 ConclusionsAntiretrovirals for PMTCT purposes have significant impact on maternal mortality as do CD4 counts and nutritional status. In resource-limited settings, PMTCT programs should provide universal HAART to all HIV+ pregnant women given its impact in prevention of maternal death.