%0 Journal Article
%T WHO 2010 Guidelines for Prevention of Mother-to-Child HIV Transmission in Zimbabwe: Modeling Clinical Outcomes in Infants and Mothers
%A Andrea L. Ciaranello
%A Freddy Perez
%A Matthews Maruva
%A Jennifer Chu
%A Barbara Engelsmann
%A Jo Keatinge
%A Rochelle P. Walensky
%A Angela Mushavi
%A Rumbidzai Mugwagwa
%A Francois Dabis
%A Kenneth A. Freedberg
%A for the CEPAC-International Investigators
%J PLOS ONE
%D 2011
%I Public Library of Science (PLoS)
%R 10.1371/journal.pone.0020224
%X Background The Zimbabwean national prevention of mother-to-child HIV transmission (PMTCT) program provided primarily single-dose nevirapine (sdNVP) from 2002¨C2009 and is currently replacing sdNVP with more effective antiretroviral (ARV) regimens. Methods Published HIV and PMTCT models, with local trial and programmatic data, were used to simulate a cohort of HIV-infected, pregnant/breastfeeding women in Zimbabwe (mean age 24.0 years, mean CD4 451 cells/¦ĚL). We compared five PMTCT regimens at a fixed level of PMTCT medication uptake: 1) no antenatal ARVs (comparator); 2) sdNVP; 3) WHO 2010 guidelines using ˇ°Option Aˇ± (zidovudine during pregnancy/infant NVP during breastfeeding for women without advanced HIV disease; lifelong 3-drug antiretroviral therapy (ART) for women with advanced disease); 4) WHO ˇ°Option Bˇ± (ART during pregnancy/breastfeeding without advanced disease; lifelong ART with advanced disease); and 5) ˇ°Option B+:ˇ± lifelong ART for all pregnant/breastfeeding, HIV-infected women. Pediatric (4¨C6 week and 18-month infection risk, 2-year survival) and maternal (2- and 5-year survival, life expectancy from delivery) outcomes were projected. Results Eighteen-month pediatric infection risks ranged from 25.8% (no antenatal ARVs) to 10.9% (Options B/B+). Although maternal short-term outcomes (2- and 5-year survival) varied only slightly by regimen, maternal life expectancy was reduced after receipt of sdNVP (13.8 years) or Option B (13.9 years) compared to no antenatal ARVs (14.0 years), Option A (14.0 years), or Option B+ (14.5 years). Conclusions Replacement of sdNVP with currently recommended regimens for PMTCT (WHO Options A, B, or B+) is necessary to reduce infant HIV infection risk in Zimbabwe. The planned transition to Option A may also improve both pediatric and maternal outcomes.
%U http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0020224