P-E7 Maternal HAART Predicts Favorable Early Infant Diagnosis outcome in North-Central Nigeria

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Abstract

Introduction:

Early Infant Diagnosis (EID) that yields a negative HIV result is the desired pediatric outcome of Prevention of Mother to Child Transmission (PMTCT) interventions. Pregnancy and breastfeeding are considered critical infectivity periods for most of Nigeria’ 380,000 HIV positive children. We explored predictors of EID outcomes among off-spring of PMTCT enrollees across 5 north central states, who had virologic polymerase chain reaction testing between October 2015 and May 2016.

Method:

Important clinical data accompany EID samples. Samples are clustered from multiple health facilities and processed at PEPFAR support-ed regional public health labs.Composite data from a single regional lab was obtained and binomial logistic regression performed to ascertain the effects of several factors on the likelihood of infants achieving a negative HIV DNA-1 result. Independent variables explored were: Female and male sex, breastfeeding status, maternal treatment regimen: prophylaxis, Highly Active Anti-Retroviral Treatment (HAARTTduring, or before index pregnancy.

Results:

A total of 3373(93.7%) samples were analyzed. 45.7% were female. Mean age of Infants’ at sample collection was 2.12 weeks. The full model with all the predictors was statistically significant χ2 (8) = 175.18, P < 0.001, indicating ability to differentiate those with successful and failed EID outcomes. The model explained between 4.8% (Cox & Snell R Square) and 15% (Nagelkerke R2) of the variance in EID outcomes and correctly classified 95.2% of the cases. However, only 2 variables were statistically significant; Maternal HAART during pregnancy and HAART before pregnancy. Controlling for other factors in the model, HAART before pregnancy and during pregnancy were 11 (OR = 10.93) & 7 (OR = 6.53) times more likely respectively, to have HIV negative infants compared to prophylaxis regimen.

Conclusions:

HAART prior to and during pregnancy is associated with an increased likelihood of achieving a favorable EID result.

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