Maternal and infant outcomes from the DREAM programme

A poster from the Drug Resource Enhancement and Malnutrition (DREAM) programme reported 12-month mother and infant data from women initiating HAART in pregnancy and continuing throughout 6 months of breastfeeding in Mozambique. [1]

In this prospective cohort study, 341 women were enrolled of whom two (0.6%) died during the period of follow up.

Of the 276/341 (81%) infants, with complete data available, 51 (15%) were lost to follow up and 14 (4.2%) died during the study period. Half of these deaths occurred in the first six months of life. Of the children who died, 13 were HIV-negative and one was HIV-positive. The investigators reported an infant mortality rate of 48.3 per 1000 live births (compared to a background rate for Mozambique in 2005 of 101 per 1000).

The majority of mothers (97.5%) in this cohort were antiretroviral naive at initiation of treatment. The mothers received AZT/3TC/NVP if their CD4 was <250 cells/mm3 and mothers with >250 cells mm3 received either LPV/r or NFV instead of NVP. Fifty-five mothers continued treatment after 6 months as they had CD4 count <200 cells/mm3 or clinical symptoms. There was one infection at 6 months among the group who continued treatment.

The investigators reported a cumulative total of 8 transmissions (2.9%) in this cohort; 4/341 (1.2%) at 1 month, 2/313 (0.6%) at 6 months and 2/276 (0.7%) at 12 months.

The median maternal viral load was 4.38 log at infant diagnosis for mothers with HIV-positive infants and 3.79 log for those with HIV-negative infants. There was no association with maternal CD4 count or viral load, or duration of HAART in this study. The investigators suggest this was due to the small numbers of transmissions overall.

A second poster from the DREAM programme looked at CD4 count, viral load, liver enzymes and haemaglobin at 12 months after treatment interruption (6 months after delivery), in women not indicated for treatment according to this programme.

At enrolment the median CD4 count among 220 women studied was 496 cells/mm3 (IQR 378 to 698), median viral load was 7850 copies/mL (IQR 2230-16,000), median haemaglobin 9.7g/dL (IQR 8.5-10.5) and liver enzymes were normal. The median duration of maternal HAART was 302 days (IQR 273-326).

Approximately 18 months after delivery, the median CD4 count was 536 cells/mm3 (IQR 367 to 669), median viral load was 5100 copies/mL (IQR 1125-14,450), median haemaglobin 11.1g/dL (IQR 10.0-11.9), median ALT was 12 (IQR 8-28). The investigators reported that all parameters evaluated did not differ significantly from baseline, p>0.05.

They wrote: These data support the safety of discontinuation of antiretroviral prophylaxis for women not meeting the criteria for treatment.