April 24, 2013
Prevention of Mother-to-Child Transmission (PMTCT) 2010 Guidelines recommend that all pregnant women with CD4 counts at or below 350 cell/mm3 or World Health Organization (WHO) stage 3 or 4 HIV start antiretroviral therapy (ART) within two weeks of diagnosis. Researchers at South Africa's Stellenbosch University report that adoption of the guidelines eliminated mother-to-child transmission (MTCT) at Tygerberg Infectious Diseases Clinic for 90 babies born to HIV-infected mothers in 2010.
In contrast, the MTCT rate at Tygerberg was 4.6 percent in 2008 and 7 percent in 2009. South Africa has the highest prevalence of HIV in the world; approximately 20 percent of women delivering at Tygerberg have the virus.
The researchers also found that the higher the CD4 count at the time of delivery, the lower the risk of HIV transmission. Study authors urged women to visit a maternity clinic as soon as they know they are pregnant so they can have HIV testing and link to care as soon as possible. Study results indicate that the risk of transmitting HIV was 10 times higher for women who had been on ART for less than eight weeks. The number of Tygerberg Clinic patients on ART for more than eight weeks increased from 47.8 percent in 2009 to 73.7 percent in 2010. Identifying bottlenecks in the referral process could speed up linkage to care.
Study authors also noted that the longer expectant mothers were on ART, the less likely they were to be lost to follow-up. They recommended increasing awareness of the benefits of visiting maternity clinics early to fast-track ART therapy.
The full report, "The Impact of Revised PMTCT Guidelines: A View from a Public Sector ARV Clinic in Cape Town, South Africa," was published online in the Journal of Acquired Immune Deficiency Syndromes (2013; doi 10.109y/QAI.0b013e31828bb721).