Work

Correction: Reduction of Maternal Mortality with Highly Active Antiretroviral Therapy in a Large Cohort of HIV-Infected Pregnant Women in Malawi and Mozambique

Year: 2013

Type: erratum

Abstract: Background: HIV infection is a major contributor to maternal mortality in resource-limited settings.The Drug Resource Enhancement Against AIDS and Malnutrition Programme has been promoting HAART use during pregnancy and postpartum for Prevention-of-mother-to-child-HIV transmission (PMTCT) irrespective of maternal CD4 cell counts since 2002.Methods: Records for all HIV+ pregnancies followed in Mozambique and Malawi from 6/2002 to 6/2010 were reviewed.The cohort was comprised by pregnancies where women were referred for PMTCT and started HAART during prenatal care (n = 8172, group 1) and pregnancies where women were referred on established HAART (n = 1978, group 2).Results: 10,150 pregnancies were followed.Median (IQR) baseline values were age 26 years (IQR:23-30), CD4 count 392 cells/mm 3 (IQR:258-563), Viral Load log 10 3.9 (IQR:3.2-4.4),BMI 23.4 (IQR:21.5-25.7),Hemoglobin 10.0 (IQR: 9.0-11.0).101 maternal deaths (0.99%) occurred during pregnancy to 6 weeks postpartum: 87 (1.1%) in group 1 and 14 (0.7%) in group 2. Mortality was 1.3% in women with ,than 350 CD4 cells/mm 3 and 0.7% in women with greater than 350 CD4s cells/mm 3 [OR = 1.9 (CL 1.3-2.9)p = 0.001].Mortality was higher in patients with shorter antenatal HAART: 22/991 (2.2%) if less than 30 days and 79/9159 (0.9%) if 31 days or greater [OR = 2.6 (CL 1.6-4.2) p,0.001].By multivariate analysis, shorter antenatal HAART (p,0.001),baseline values for CD4 cell count (p = 0.012), hemoglobin (p = 0.02), and BMI (p,0.001) were associated with mortality.Four years later, survival was 92% for women with shorter antenatal HAART and 98% for women on established therapy prior to pregnancy, p = 0.001.Conclusions: Antiretrovirals for PMTCT purposes have significant impact on maternal mortality as do CD4 counts and nutritional status.In resource-limited settings, PMTCT programs should provide universal HAART to all HIV+ pregnant women given its impact in prevention of maternal death.

Source: PLoS ONE

DOI: 10.1371/annotation/9ab4708e-650e-411a-b72f-bb85e0845469