Source: Abt Associates (Cambridge, MA)
BETHESDA, MD — Providing life-long antiretroviral treatment to HIV-infected pregnant women not only prevents HIV infections in infants, but also improves the 10-year survival rate in mothers, saving more than 250,000 maternal life years and reducing the likelihood that children born to these mothers will become orphans, a study published today in the journal PLOS ONE found.
Transmission of HIV during pregnancy, labor, delivery or breastfeeding is the main mode of HIV infection in children. An estimated 390,000 children worldwide acquired HIV from their mothers in 2010, with more than 90 percent of these new infections occurring in sub-Saharan Africa.
Malawi, a low-income country of 15 million people, is one of the countries with the highest number of HIV-infected pregnant women.
The study from Abt Associates' Dr. Carlos Avila and colleagues examined how the Ministry of Health in Malawi is implementing a new program termed Option B+, in which all pregnant women who test HIV positive are placed on antiretroviral therapy (ART) for life, regardless of their CD4 count or clinical stage.
They looked at whether the program represents a cost-effective policy option for treating HIV-infected pregnant women and for preventing mother-to-child transmission, as compared with World Health Organization guidelines (Option A and B) to prevent mother-to-child transmission of HIV. Those guidelines recommend antiretroviral therapy for women with CD4 counts at or lower than 350 cells per microliter, which presents a major restriction in areas where lab resources are scarce. Under WHO Option A, the mother receives antiretrovirals at three different stages of pregnancy and then for a week after childbirth. Under WHO Option B, the mother takes a triple antiretroviral regimen at 14 weeks, and continues taking this treatment until the child is born. Antiretrovirals are suspended after delivery, or one week after all infant exposure to breast milk has ended. The infants receive antiretroviral prophylaxis.
Researchers used data from Malawi to simulate the progression of HIV among a group of HIV-infected pregnant women who received preventive and antiretroviral therapy, and estimated the number of pediatric infections averted and maternal life years gained over a 10-year period. They found that providing lifelong antiretroviral treatment to all mothers would improve 10-year survival in mothers more than four-fold, saving more than 250,000 maternal life years, as compared to mothers receiving other treatment options, which saved 153,000 and 172,000 life years respectively. In addition, providing ARTs for all HIV-infected pregnant women could save $455 U.S. per life year gained.
"Although providing these drugs may cost more in the short term, it will save many lives, prevent future infant infections and reduce the chances that a child will become an orphan in the long term," said Avila, a senior health economist at Abt. "This study takes into account the realities of providing antiretrovirals in rural Africa, where lab facilities are scarce and requirements to start treatment based on CD4 counts are a major impediment to mothers getting the treatment they need."
The researchers also note that simplifying drug regimen options may improve adherence to therapy and can help overcome some of the individual, organizational and societal barriers to achieving high coverage levels of prophylaxis and treatment.