Ngemu Erastus K, Khayeka-Wandabwa Christopher, Kweka Eliningaya J, Choge Joseph K, Anino Edward, Oyoo-Okoth Elijah
Tropical Pesticides Research Institute, Division of Livestock and Human Diseases Vector Control, Mosquito Section, Ngaramtoni, Off Nairobi road, PO Box 3024, Arusha, Tanzania.
BMC Res Notes. 2014 Jan 21;7:52. doi: 10.1186/1756-0500-7-52.
Ensuring that no baby is born with HIV is an essential step towards achieving an AIDS-free generation. To achieve this, strategies that decouple links between childbirth and HIV transmission are necessary. Traditional forms of prevention of mother-to-child transmission of HIV (PMTCT), has been recommended. Recognizing the importance and challenges of combination of methods to achieve rapid PMTCT, the World Health Organization (WHO) recommended option B Highly Active Antiretroviral Therapy (HAART) for all HIV-positive pregnant women. This study aimed to evaluate the effectiveness of the HAART in PMTCT. A cohort of HIV-infected pregnant women in Kenya were obtained from the DREAM Center, Nairobi. The study participants underwent adherence counselling and Option B of HAART [Nevirapine(NVP) + Lamivudine + Zidovudine] at the fourth week of gestation followed by an intravenous NVP administration intrapartum and postpartum NVP syrup to the respective infants for six weeks. Absolute pre-HAART and post-HAART CD4 counts and viral loads counts were determined. Comparison of the CD4 counts and viral loads before and after administration of HAART were done using Wilcoxon's Matched Pairs Signed-Ranks Test.
The mean absolute CD4 cell counts in mothers after administration of HAART was significantly higher (Z = 15.664, p < 0.001) than before the administration of HAART). Also the viral load of the mothers significantly (Z = 11.324, p < 0.001) reduced following HAART treatment. Following the HAART administration in mothers, up to 90% of children were confirmed to be HIV negative.
Administration of HAART to mothers and children demonstrated an effective mechanism of PMTCT. However, other aspects of HAART such as adherence, costs, mothers behaviour during HAART, and the child feeding programme during the therapy should further be evaluated and ascertained how they can affect the overall efficacy of option B HAART in PMTCT.
确保没有婴儿感染艾滋病毒出生是迈向无艾滋病一代的关键一步。要实现这一目标，有必要采取切断分娩与艾滋病毒传播之间联系的策略。传统的预防母婴传播艾滋病毒（PMTCT）方法已被推荐。认识到采用多种方法实现快速预防母婴传播艾滋病毒的重要性和挑战，世界卫生组织（WHO）建议对所有艾滋病毒呈阳性的孕妇采用B方案高效抗逆转录病毒疗法（HAART）。本研究旨在评估HAART在预防母婴传播艾滋病毒方面的有效性。从内罗毕的梦想中心选取了一组肯尼亚感染艾滋病毒的孕妇。研究参与者在妊娠第四周接受依从性咨询并采用HAART的B方案[奈韦拉平（NVP）+拉米夫定+齐多夫定]，随后在分娩时静脉注射NVP，并在产后给各自的婴儿服用六周的NVP糖浆。测定HAART治疗前和治疗后的绝对CD4细胞计数及病毒载量计数。使用威尔科克森配对符号秩检验对HAART给药前后的CD4细胞计数和病毒载量进行比较。
HAART给药后母亲的平均绝对CD4细胞计数显著高于（Z = 15.664，p < 0.001）给药前。母亲的病毒载量在接受HAART治疗后也显著（Z = 11.324，p < 0.001）降低。母亲接受HAART治疗后，高达90%的儿童被确认为艾滋病毒阴性。
对母亲和儿童施用HAART证明是预防母婴传播艾滋病毒的有效机制。然而，HAART的其他方面，如依从性、成本、母亲在HAART期间的行为以及治疗期间的儿童喂养方案，应进一步评估并确定它们如何影响B方案HAART在预防母婴传播艾滋病毒方面的总体疗效。
