Managing HIV in pregnancy: comparing infant HIV outcomes in mothers treated prophylactically with AZT monotherapy for HIV against those on lifelong HAART (Highly Active Anti-Retroviral therapy) in Kenya

Abstract

Background: The prevention of the mother to child transmission (PMTCT) of HIV (Human immunodeficiency virus) program is credited for the reduction of mother to child transmission of HIV. It has achieved the unprecedented below 2% MTCT (mother-to-child-transmission) in developing economies. However, developing countries especially in the sub Saharan Africa continue to grapple with resource constraints and runaway mother to child HIV transmission trends which contribute to over 90% of global paediatric HIV infections. As a sequel of resource constraints, access to effective antiretroviral therapy is curtailed. The PMTCT application therefore takes different approaches from country to country in adaptation to prevailing state of affairs. The Kenyan program employs AZT based monotherapy for HIV infected pregnant mothers with high CD4 and HAART for those with severe form of HIV disease in pregnancy. With the Kenyan MTCT rate projected at 10% in the year 2014, the study interrogates and compares the effectiveness of the two prophylactic PMTCT interventions employed in the Nakuru county hospital, Kenya. Objective: To unravel and compare the MTCT rates of HIV among exposed infants whose mothers received AZT monotherapy and those whose mothers were treated with HAART (highly active antiretroviral therapy) respectively in the Nakuru county hospital, Kenya. Design: Retrospective review of the medical records of participant cohorts followed through pregnancy, delivery and the subsequent HIV testing of infants in the postpartum period. Methods: After getting the nod from respective ethical review boards, the participants’ relevant medical records were reviewed between July 2011 and July 2014. Randomization was achieved through the random number generator. Data analysis was handled using the Stata version 11.0 software (Stata Corporation, College Station, Texas, USA). Results: The MTCT rate is encouragingly below 2% with no differences in transmission rates observed between mother- infant pairs on HAART from those on AZT based monotherapy. However challenges persist on getting laboratory monitoring indices performed satisfactorily. In addition, a high rate of false positivity of infant ELISA HIV tests were noted, heralding a declining epidemic prevalence. Poor adherence punctuated by failure to undergo CD4 notably resulted in all infant HIV infections identified in this study. Conclusion: Both AZT based monotherapy and HAART PMTCT prophylaxis have achieved a reduced MTCT to below 2% in Nakuru county hospital mirroring results posted by developing economies. The monitoring of HIV disease progression and treatment outcomes are however wanting if timely initiations of therapy as well as the management of side effects and clinical failures are to be realized. Though not a reliable diagnostic tool for infant HIV infections, the ELISA antibody test outcomes could be utilized as a predictor of prevalence trends.