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24-month HIV-free survival among infants born to HIV-positive women enrolled in Option B+ program in Kigali, Rwanda: The Kabeho Study.

Abstract Lifelong antiretroviral therapy (ART) provision to all pregnant HIV-positive women ("Option B+") has been recommended by the World Health Organization since 2013, but there remain limited data on the effects of Option B+ on long-term HIV-free survival in breastfeeding HIV-exposed infants. The Kigali Antiretroviral and Breastfeeding Assessment for the Elimination of HIV (Kabeho) study enrolled HIV-positive women from the third trimester of pregnancy to 2 weeks postpartum in 14 heath facilities implementing Option B+ in Kigali, Rwanda. Mother-child pairs in the longitudinal observational cohort were followed until 24 months postpartum, with HIV diagnostic testing at 6 weeks, and 9, 18 and 24 months. The Kaplan-Meier method was used to estimate HIV transmission, survival, and HIV-free survival through 24 months. We enrolled 608 HIV-positive women in 2013-2014; birth outcome data were available for 600 women and 597 live-born infants. By 6 weeks, 11 infants had died and 3 infants had confirmed HIV infection (0.5% transmission; 95% confidence interval [CI] 0.2-1.6). At 9 months, there were 9 additional deaths and 2 new infections (cumulative transmission 0.9%, 95% CI 0.4-2.2). At 18 months, there were 6 additional deaths and no new infant infections. At 24 months, there were no additional child deaths and 1 new infection (cumulative 2.2%, 95% CI 0.7-7.0), for an overall 24-month HIV-free survival of 93.2% (95% CI 89.5-95.6). Low transmission rates and high HIV-free survival at 24 months were achieved in breastfeeding infants of HIV-positive mothers receiving universal ART in urban health facilities in Rwanda, though vigilance on maintaining viral suppression for ART-experienced women is needed.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29390577
OWN - NLM
STAT- MEDLINE
DCOM- 20180212
LR  - 20180212
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 51
DP  - 2017 Dec
TI  - 24-month HIV-free survival among infants born to HIV-positive women enrolled in
      Option B+ program in Kigali, Rwanda: The Kabeho Study.
PG  - e9445
LID - 10.1097/MD.0000000000009445 [doi]
AB  - Lifelong antiretroviral therapy (ART) provision to all pregnant HIV-positive
      women ("Option B+") has been recommended by the World Health Organization since
      2013, but there remain limited data on the effects of Option B+ on long-term
      HIV-free survival in breastfeeding HIV-exposed infants. The Kigali Antiretroviral
      and Breastfeeding Assessment for the Elimination of HIV (Kabeho) study enrolled
      HIV-positive women from the third trimester of pregnancy to 2 weeks postpartum in
      14 heath facilities implementing Option B+ in Kigali, Rwanda. Mother-child pairs 
      in the longitudinal observational cohort were followed until 24 months
      postpartum, with HIV diagnostic testing at 6 weeks, and 9, 18 and 24 months. The 
      Kaplan-Meier method was used to estimate HIV transmission, survival, and HIV-free
      survival through 24 months. We enrolled 608 HIV-positive women in 2013-2014;
      birth outcome data were available for 600 women and 597 live-born infants. By 6
      weeks, 11 infants had died and 3 infants had confirmed HIV infection (0.5%
      transmission; 95% confidence interval [CI] 0.2-1.6). At 9 months, there were 9
      additional deaths and 2 new infections (cumulative transmission 0.9%, 95% CI
      0.4-2.2). At 18 months, there were 6 additional deaths and no new infant
      infections. At 24 months, there were no additional child deaths and 1 new
      infection (cumulative 2.2%, 95% CI 0.7-7.0), for an overall 24-month HIV-free
      survival of 93.2% (95% CI 89.5-95.6). Low transmission rates and high HIV-free
      survival at 24 months were achieved in breastfeeding infants of HIV-positive
      mothers receiving universal ART in urban health facilities in Rwanda, though
      vigilance on maintaining viral suppression for ART-experienced women is needed.
CI  - Copyright (c) 2017 The Authors. Published by Wolters Kluwer Health, Inc. All
      rights reserved.
FAU - Gill, Michelle M
AU  - Gill MM
AD  - Elizabeth Glaser Pediatric AIDS Foundation.
FAU - Hoffman, Heather J
AU  - Hoffman HJ
AD  - Department of Epidemiology and Biostatistics, Milken Institute School of Public
      Health, The George Washington University, Washington, DC.
FAU - Ndatimana, Dieudonne
AU  - Ndatimana D
AD  - Elizabeth Glaser Pediatric AIDS Foundation.
FAU - Mugwaneza, Placidie
AU  - Mugwaneza P
AD  - Rwanda Biomedical Center/Ministry of Health.
FAU - Guay, Laura
AU  - Guay L
AD  - Elizabeth Glaser Pediatric AIDS Foundation.
AD  - Department of Epidemiology and Biostatistics, Milken Institute School of Public
      Health, The George Washington University, Washington, DC.
FAU - Ndayisaba, Gilles F
AU  - Ndayisaba GF
AD  - Elizabeth Glaser Pediatric AIDS Foundation.
FAU - Bobrow, Emily A
AU  - Bobrow EA
AD  - Elizabeth Glaser Pediatric AIDS Foundation.
FAU - Asiimwe, Anita
AU  - Asiimwe A
AD  - Rwanda University Teaching Hospitals (CHU), Kigali, Rwanda.
FAU - Mofenson, Lynne M
AU  - Mofenson LM
AD  - Elizabeth Glaser Pediatric AIDS Foundation.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Anti-HIV Agents)
SB  - AIM
SB  - IM
MH  - Adult
MH  - Anti-HIV Agents/*therapeutic use
MH  - Child, Preschool
MH  - Female
MH  - HIV Infections/epidemiology/*prevention & control
MH  - Humans
MH  - Infant
MH  - Infant Mortality
MH  - Infant, Newborn
MH  - Infectious Disease Transmission, Vertical/*prevention & control/statistics &
      numerical data
MH  - Male
MH  - Pregnancy
MH  - Pregnancy Complications, Infectious/virology
MH  - Pregnancy Outcome
MH  - Rwanda
PMC - PMC5758279
EDAT- 2018/02/03 06:00
MHDA- 2018/02/13 06:00
CRDT- 2018/02/03 06:00
PHST- 2018/02/03 06:00 [entrez]
PHST- 2018/02/03 06:00 [pubmed]
PHST- 2018/02/13 06:00 [medline]
AID - 10.1097/MD.0000000000009445 [doi]
AID - 00005792-201712220-00164 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Dec;96(51):e9445. doi: 10.1097/MD.0000000000009445.