Mother-to-child transmission outcomes of HIV-exposed infants followed up in Jos North-central Nigeria

Abstract

Objective: Since 2010, Nigeria adopted World Health Organization (WHO) ‘Option B’ which required administration of triple antiretroviral prophylaxis or treatment (ART) to all HIV-infected pregnant women. We studied the transmission outcomes of HIV-exposed children up to 18 months of age. Design: This was a retrospective, observational study of HIV-infected pregnant women and their exposed infants that accessed prevention of mother to child transmission (PMTCT) services at Jos University Teaching Hospital, Jos, North-central Nigeria. Methods: HIV-infected women were enrolled during antenatal care or at labor/delivery between January 1, 2010 and December 31, 2012. Antiretroviral (ARV) prophylaxis/therapy was provided according to the 2010 Nigerian PMTCT guidelines (adapted WHO 2010 guidelines); Infant HIV diagnosis was performed at 6 weeks and at 6 months. HIV antibody diagnosis was used for exposed children at 18 months. Results: A total of 996 HIV-exposed children were followed up. Of those children, 140 (14.1%) were lost to follow up by 18 months of age. Twelve children (1.4%) died (all HIV negative) before 18 months of age and six infants (0.7%) were confirmed to be HIV-infected (4 by the age of 6 months and 2 thereafter) and were referred for treatment. A total of 838 (84.1%) children tested HIV negative at 18 months and were discharged. Mother-to-child transmission (MTCT) of HIV by 18 months was lower among women on ART before pregnancy compared to those women who started ART/Triple ARV prophylaxis during pregnancy/delivery. (0.4%; 3/700 vs 2.0%; 3/150 P=0.05) Home delivery was associated with higher transmission than facility delivery (p=0.03).Mode of delivery or method of infant feeding had no significant impact on vertical transmission by 18 months. Conclusions: In North-central Nigeria where HIV is prevalent, ART started before pregnancy is enormously effective in preventing mother-to-child transmission. Adoption of WHO ‘Option B+’ deserves serious consideration in such settings