Effect of triple drug antiretroviral therapy on CD4+ count in pregnant women with HIV and prevention of parent to child transmission

Akanksha Dwivedi; Ratan Gupta; Kailash C. Agarwal; Kumari U. Rani

doi:10.18203/2320-1770.ijrcog20204793

Authors

Akanksha Dwivedi Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
Ratan Gupta Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
Kailash C. Agarwal Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
Kumari U. Rani Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20204793

Keywords:

HIV, ART, Triple drug, CD4 count

Abstract

Background: India has moved from single drug Antiretroviral Therapy (ART) in 2002 to triple drug ART in 2013 to prevent parent to child transmission of HIV. The aim of the study was to know the effects of triple drug ART on maternal CD4+ count and prevention of HIV transmission to baby along with its adherence, side effects and pregnancy outcome.

Methods: A prospective study wsas done in Safdarjung Hospital, New Delhi on 40 HIV positive pregnant women who received single dose combination of triple drug ART. CD4+ count, LFT and KFT were done before beginning of ART and repeated after 6 months of ART. The infants received nevirapine prophylaxis and HIV status was determined by DBS PCR at 6 weeks.

Results: The median CD4+ count was 317 and 397 pre and post ART for 6 months respectively (p value<0.001. Low birth weight (LBW) was seen in 43.59% which was statistically significant but confounded as 76.4% of these babies were preterm. 23.08% of babies had an APGAR of < 7 at 1 minute, out of which 77.7% were preterm. Nine out of 39 infants (one had abortion) needed NICU admission. Only one baby (2.56%) was HIV positive who died at 4 months of age due to pneumonia. There was no defaulter and no statistically significant changes in LFT and KFT after 6 months of ART.

Conclusions: Triple drug ART offers greater convenience improves fetomaternal outcome and minimize the risk of HIV transmission from mother to child.

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References

John GC, Kreiss J. Mother to child transmission of human immunodeficiency virus type 1. Epidemiol Rev. 1996;18(2):149-57.

Connor EM, Sperling RS, Gelber R, Kiesler P, Scott G, O’Sullivan J, et al. Reduction of maternal infant transmission of human immunodeficiency virus type1 with zidovudine treatment. N Engl J Med. 1994; 331:1173-80.

Shaffer N, Chuachoowong R, Mock PA, Bhadrakom C, Siriwasin W, Young N, et al. Short-course zidovudine for perinatal HIV-1 transmission in Bangkok, Thailand: a randomized controlled trial. Bangkok Collaborative Perinatal HIV Transmission Study Group. Lancet. 1999;353:773-80.

Jamieson DJ, Sibailly TS, Sadek R, Roels TH, Ekpini ER, Ouattara BE, et al. HIV-1 viral load and other risk factors for mother-to-child transmission of HIV-1 in a breast-feeding population in Cote d'Ivoire. J Acquir Immune Defic Syndr. 2003;34:430-6.

Jackson JB, Musoke P, Fleming T, Guay LA, BagendaD, Allen M, et al. Intrapartum and neonatal single dose nevirapine compared with zidovudine for prevention of mother to child transmission of HIV-1 in Kampala, Uganda: 18-month follow-up of the HIVNET 012 randomised trial. Lancet. 2003;362:859-68.

John GC, Nduati RW, Ngacha DA, Richardson BA, Penteleeff D, Mwatha A, et al. Correlates of mother to child human immunodeficiency virus type 1 (HIV-1) transmission: association with maternal plasma HIV-1 RNA load, genital HIV-1 DNA shedding, and breast infections. J Infect Dis. 2001;183:206-12.

World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection, second edition. June 2016. Available at https://www.who.int/hiv/pub/arv/arv-2016/en/. Accessed on 25 April 2019.

Nataraj S, Ramanathan M. The prevention of parent-to-child transmission programme: Is it fair to women? Indian J Med Ethics. 2014;11:71-5.

World Health Organization. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. September 2015. Available at https://apps.who.int/iris/bitstream/handle/10665/186275/9789241509565_eng.pdf;jsessionid=AC5D25D56DC12A5F2A464716CBDF9A4A?sequence=1. Accessed on 25 April 2019.

NACO National technical guidelines on Antiretroviral treatment, October 2018.Available at http:// naco. gov. in/ sites/ default/ files/ NACO%20-%20National%20Technical%20Guidelines%20on%20ART_October%202018%20%281%29.pdf. Accessed on 22 March 2020.

Hoffman RM, Black V, Technau K, Merwe KJ, Currier J, Coovadia A, et al. Effects of highly active antiretroviral therapy duration and regimen on risk for mother to child transmission of HIV in Johannesburg, South Africa. J Acquir Immune Defic Syndr. 2010;54:35-41.

Read PJ, Mandalia S, Khan P, Harrison U, Naftalin C, Gilleece Y, et al. When should HAART be initiated in pregnancy to achieve an undetectable HIV viral load by delivery? AIDS. 2012;26:1095-103.

Modified Kuppuswami socioeconomic status scale. Available at https:/ /www. researchgate. Net /publication/ 323846030 _MODIFIED _KUPPUSWAMY_SCALE_UPDATED_FOR_YEAR_2018. Accessed on 25 April 2019.

Dadhwal V, Sharma A, Khoiwal K, Deka D, Sarkar P, Vanamail P. Pregnancy outcomes in HIV-infected women: experience from a tertiary care center in India. IJMA. 2017;6:75-81.

Gautam S, Shah T. Study of perinatal outcome in human immunodeficiency virus positive women. Int J Reprod contracept Obstet Gynecol. 2016;5:2587-91.

Dinh TH, Mushavi A, Shiraishi RW, Barr BT, Balachandra S, Shambira G, et al. Impact of timing of antiretroviral treatment and birth weight on mother-to-child human immunodeficiency virus transmission: findings from an 18-month prospective cohort of a nationally representing sample of mother-infant pairs during the transition from Option A to Option B+ in Zimbabwe. CID. 2018;66:576-85.

Gibango NN, Mda S, Ntuli TS. Factors associated with delivering premature and/or low birth weight infants among pregnant HIV positive women on antiretroviral treatment at Dr George Mukhari Hospital, South Africa. South African J Infect Dis. 2017;33:42-5.

Yadav S, Joshi R, Kale V. Study of factors affecting maternal and fetal outcome in HIV positive women. Int J Reprod Contracept Obstet Gynecol 2017;6:256-61

Radhika AG, Chawla S, Bhaskaran S. Prevention of parent to child transmission of HIV: single centre experience of 14 years at tertiary care hospital in Delhi, India. JCDR. 2017;11:4-7.

Girma M, Wendaferash R, Shibru H, Berhane Y, Hoelscher M, Kroidl A. Uptake and performance of PMTCT in Ethiopia. Trop Med Int Health. 2017;22:765-75.