Abstract

Introduction: Paediatric Human Immunodeficiency Virus (HIV) infection remains a Public Health issue in developing countries. Survival of HIV-infected children is closely related to early combined antiretroviral therapy (cART). Thus, it is very important to improve access to Prevention of Mother To Child Transmission of HIV (PMTCT), diagnosis and care. This study at assessing Mother to Child Transmission of HIV (MTCT) and to identify factors associated with MTCT in infants born of HIV-infected mothers and routinely followed in referral pediatric hospital in Yaounde, Cameroon.

Methods: In this cohort study, we included all the HIV-exposed infants who attended at least once the Day Care Unit of the “Centre Mère et Enfant de Yaoundé”, Chantal Biya Foundation, Cameroon, from 2009 to 2013. The Early Infant Diagnosis of HIV (EID) using Polymerase Chain Reaction (PCR) was proposed from the age of 6 weeks, and the HIV serology was conducted from the age of 12 months. HIV-exposed infants were classified according to HIV status as following: 1) HIV-infected infants, 2) HIV-uninfected infants, 3) infants not tested or with no HIV test result available. Association between the HIV status outcome and the exposure variables was assessed using multivariate logistic regression, including factors with a p-value < 0.20 in univariate analysis and other potential risk factors of MTCT. Infants with indeterminate HIV status were excluded both in univariate and multivariate analysis.

Results: Of 2,768 HIV-exposed infants, 2068 were HIV-uninfected (1 death, 1150 uncompleted follow-up), 322 were HIV-infected (19 deaths, 8 uncompleted follow-up) and 378 were not tested for HIV status or with no result available (23 deaths). Mean follow-up=260 days. 1,434 boys and 1,334 girls. When the mother and/or the infant received any antiretroviral treatment, MTCT was 5.64% versus 43.6% when mother and child received nothing as a treatment. The main factor associated with lower MTCT was history of any antiretroviral treatment in HIV-infected mother or HIV-exposed infant. Artificial feeding and antenatal monitoring of HIV-infected mother in a referral hospital were also associated with lower MTCT.

Conclusion: In a routine program, as expected, MTCT is much more important among HIV-exposed infants or mothers who did not have access to antiretroviral drugs for PMTCT. Moreover, access to HIV testing and PMTCT must be increased, especially in private and peripheral level health facilities.

Keywords: Child Transmission; HIV; PMTCT

References

1. Global AIDS Update 2016.
2. WHO | Global guidance on criteria and processes for validation: Elimination of Mother-to-Child Transmission of HIV and Syphilis.
3. Connor EM., et al. “Reduction of maternal-infant transmission of Human Immunodeficiency virus type 1 with zidovudine treatment”. Pediatric AIDS Clinical Trials Group Protocol 076 study group. The New England Journal of Medicine 331 (1994): 1173-1180.
4. Warszawski J., et al. “Mother-to-child HIV transmission despite antiretroviral therapy in the ANRS French Perinatal Cohort”. AIDS 2 (2008): 289-299.
5. WHO | Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants. WHO. World Health Organization.
6. WHO | Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. WHO. World Health Organization.
7. Ateba Ndongo F., et al. “Virologic Response to Early Antiretroviral Therapy in HIV-infected Infants: Evaluation After 2 Years of Treatment in the Pediacam Study, Cameroon”. The Pediatric Infectious Disease Journal 1 (2018): 78–84.
8. Tejiokem MC., et al. “Feasibility of Routinely Offering Early Combined Antiretroviral Therapy to HIV-infected Infants in a Resource-limited Country: The ANRS-PediaCAM Study in Cameroon”. The Pediatric Infectious Disease Journal 10 (2015): e248-253.
9. Dabis F., et al. “Six-month efficacy, tolerance, and acceptability of a short regimen of oral zidovudine to reduce vertical transmission of HIV in breastfed children in Côte d’Ivoire and Burkina Faso: a double-blind placebo-controlled multicentre trial. DITRAME Study Group. DIminution de la Transmission Mère-Enfant”. Lancet (London England)9155 (1999): 786–792.
10. Guay LA., et al. “Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial”. Lancet (London England) 354.9181 (1999): 795–802.
11. Dabis F., et al. “Field efficacy of zidovudine, lamivudine and single-dose nevirapine to prevent peripartum HIV transmission”. AIDS 3 (2005): 309–318.
12. Kesho Bora Study Group, de Vincenzi I. “Triple antiretroviral compared with zidovudine and single-dose nevirapine prophylaxis during pregnancy and breastfeeding for prevention of mother-to-child transmission of HIV-1 (Kesho Bora study): a randomised controlled trial”. Lancet Infection Disease3 (2011): 171–180.
13. Kigen HT., et al. “Predictors of loss to follow up among HIV-exposed children within the prevention of mother to child transmission cascade, Kericho County, Kenya, 2016”. Pan African Medical Journal (2018).
14. Sibanda EL., et al. “The magnitude of loss to follow-up of HIV-exposed infants along the prevention of mother-to-child HIV transmission continuum of care: a systematic review and meta-analysis”. AIDS London England17 (2013): 2787–2797.
15. Kalembo FW and Zgambo M. “Loss to Followup: A Major Challenge to Successful Implementation of Prevention of Mother-to-Child Transmission of HIV-1 Programs in Sub-Saharan Africa”. (2012): e589817.
16. Tchikankou AF., et al. “Pratiques alimentaires des nourrissons exposés au VIH suivis à l’unité de jour du centre mère et enfant de la Fondation Chantal Biya 2009-2011”. Poster DPo2.4 7è Conférence Francophone VIH/SIDA, (AFRAVIH 2014), France, Montpellier, 27-30 avril, (2014).
17. Tejiokem MC., et al. “Feasibility of Early Infant Diagnosis of HIV in Resource-Limited Settings: The ANRS 12140-PEDIACAM Study in Cameroon. Myer L, editor”. Plos One 7 (2011): e21840.

Citation

Citation: Ateba Ndongo Francis., et al. “Reporting of Five Years Mother to Child Transmission of HIV among HIV-Exposed Infants Followed from 2009-2013 in the “Centre et Mère et Enfant de Yaoundé”, Chantal Biya Foundation, Cameroon". Acta Scientific Women's Health 2.9 (2020): 03-09.

Copyright

Copyright: © 2020 Ateba Ndongo Francis., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.