Trends of HIV infection among infants born to HIV infected mothers on PMCT antiretroviral treatment in western Kenya.

Abstract

Background : More than 365,000 of unborn children are at risk of getting HIV infection in the developing world through "vertical" transmission. Although, ARVs are being used to reduce maternal HIV transmission, limited information exists indicating their impact on the trend of HIV prevalence among infants born to HIV infected mothers.

Objective : To determine the trend of HIV infection among infants born to HIV infected mothers in relation to specific ARVs administered to pregnant women and lactating mothers of 18 months and below infants.

Methodology : Dried blood spot samples in the following quantities per year thus, in 2010, n = 4,210, in 2011, n=4,093, in 2012, n=4,686, in 2013, n=3,080 were collected from infants aged ≤18 months whose mothers were HIV positive. The samples were analyzed using Cobas Polymerase Chain Reaction Assay in early infant diagnosis laboratory at the Center for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute (KEMRI).

Results: Out of the total number of samples tested 2010, 409(9.7%) tested HIV positive. In 2011, 350(8.5%), in 2012, 368(7.9%) and in 2013, 221(7.2%) were HIV positive respectively. The trend of HIV in infants whose mothers had been put on various ARVs was as follows: AZT+3TC +EFV, in 2010, the number was 10.4%. In 2011, it moved to 9.1%, in 2012, to 6.3% and 2013, dropped to 6.0%. AZT+3TC+NVP, in 2010, the number was 7.1%, in 2011, moved to 6.1%, in 2012, falling to 4.7% and 2013 to3.9%. SdNVP, in 2010, the number was 10.3%. In 2011, moved to 7.4%, in 2012, dropping to 6.2% and in 2013, at 6.0%. Those mothers who had not been given any ARVs, their infants had HIV prevalence as follows: in 2010, the number was 11.2%. In 2011, it climbed to 12.6%, moving to 12.7% in 2012, and 12.9% in 2013.

Conclusion: There was direct relationship between specific ARV administration and HIV infection among those infants. That was evident by the fact that, HIV appeared to decrease with sub-sequent years of provision of specific drugs. However, HAART (AZT+3TC+ EFV) seemed to provide greater impact in HIV prevention compared to other HAART (AZT+3TC+NVP) and SdNVP. The worst groups are those not on any ARVs. Single-dose Nevirapine commonly is used for prevention event-hough prior studies have shown exposure to it develop drug resistance, which can compromise the effective not only of itself, but also other non-nucleoside reverse transcriptase inhibitors (NNRTIs)

Recommendation : There is need for all HIV positive pregnant women to be put on ARVs and monitored for ARVs uptake to reduce the transmission of HIV from mother to child.

Key words: HIV, ARVs, Infants,