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. 2017 Dec;96(51):e9445.
doi: 10.1097/MD.0000000000009445.

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

Michelle M Gill  1 , Heather J Hoffman, Dieudonne Ndatimana, Placidie Mugwaneza, Laura Guay, Gilles F Ndayisaba, Emily A Bobrow, Anita Asiimwe, Lynne M Mofenson
Affiliations

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

Michelle M Gill et al. Medicine (Baltimore). 2017 Dec.

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.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Follow-up of Kabeho study infants. Children remaining in the cohort following delivery and through 24 months of age at HIV testing time points of 6 weeks, 9, 18, and 24 months. Children who died, transferred out of study facilities or whose caregivers withdrew their consent were terminated. Other infants who were expected at these time points but did not return for any further study visits were considered lost to follow-up (LTFU).
Figure 2
Figure 2
Kaplan–Meier cumulative probabilities of child mortality (blue), HIV transmission (red) and HIV-free survival (yellow) up to age 24 months.
See this image and copyright information in PMC

References

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    1. Gill MM, Hoffman HJ, Bobrow EA, et al. Detectable viral load in late pregnancy among women in the Rwanda option B+ PMTCT program: enrollment results from the Kabeho study. PLoS One 2016;11:e0168671. - PMC - PubMed

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