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Observational Study
. 2013 Aug 19;8(8):e71653.
doi: 10.1371/journal.pone.0071653. eCollection 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  1 , 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
Affiliations
Observational Study

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

Giuseppe Liotta et al. PLoS One. .

Erratum in

Abstract

Background: 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.

Methods: 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).

Results: 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 than 30 days and 79/9159 (0.9%) if 31 days or greater [OR = 2.6 (CL 1.6-4.2) p<0.001]. By multivariate analysis, shorter antenatal HAART (p<0.001), baseline values for CD4 cell count (p = 0.012), hemoglobin (p = 0.02), and BMI (p<0.001) were associated with mortality. Four years later, survival was 92% for women with shorter antenatal HAART and 98% for women on established therapy prior to pregnancy, p = 0.001.

Conclusions: Antiretrovirals 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.

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Conflict of interest statement

Competing Interests: The authors declare that none of the commercial funders (Intesa Sanpaolo and the AiPB- Associazione Italiana Private Banking) had any participation in the present study. None of the authors have any commercial interests, employment, consultancy, patents or products in development or marketed products in association with any of the funders or any other organization. This does not alter their adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Kaplan-Meier maternal survival analysis according to length of pre-delivery HAART.
Figure 2
Figure 2. Kaplan-Meier maternal survival analysis according to baseline parameters: BMI, HIV-1 viral load, CD4 cell count and hemoglobin values.
See this image and copyright information in PMC

References

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