ABSTRACT
The purpose of this research is to evaluate the impact of combined use of Nevirapine and Zidovudine in prevention of pregnant mothers to child transmission of HIV in high risk in babies in Adamawa State, Nigeria. Cross-sectional study design was used to compare perinatal transmission rates of HIV in two sets of mothers: ARV-treated mothers and ARV-untreated mothers. 109 treated and 90 naïve mother-infant pairs were recruited. HIV transmission rates were similar in the nevirapine (10/ 61) and AZT (8/ 48) groups (16.4% vs. 16.7%) respectively but higher in the naïve group (43/ 90 48%, p= 0.0001). ARV therapy offers a protective effect against MTCT of HIV (Adjusted Odds Ratio 0.22 95%CI 0.09, 0.54) but mothers in Stage 1 and 2 of disease were more likely to benefit from this intervention than mothers in Stage 3 and 4.
In this community-based observational study, ARV reduces the risk of prenatal transmission of HIV but does not eliminate the risk completely. Early screening of asymptomatic pregnant women will identify a group of mothers more likely to benefit from the intervention.
CHAPTER ONE
1.0 INTRODUCTION
1.1 Background of the Study
Each year 590,000 infants acquire HIV-1 infection from their mothers, mostly in developing countries that are unable to implement antiretroviral interventions now standard in the industrialized world 1. Initial interventions to prevent transmission are expensive and technically complex and not feasible for use in developing countries with limited resources. A series of randomized clinical trials have been completed to assess the effectiveness of oral antiretroviral therapy (ART) regimens 2-5. More relevant to the situation would be oral regimens at low cost. These clinical trials provide efficacy but do not provide information as to how the intervention will work in practice. Before 2000, in Nigeria, the use of ART in the prevention of mother-to-child transmission (MTCT) of HIV had been carried out only under clinical trial conditions. At the beginning of the year 2000, the Nigerian Ministry of Health and UNICEF began a program to implement therapeutic regimens at 3 hospitals in Adamawa State, Nigeria. This new program provided an opportunity to assess the effectiveness of antiretroviral (ARV) use among pregnant women outside the clinical trial setting. In this community-based observational study, we estimate and compare the perinatal transmission rates of HIV-1 among mothers who received ART through the implementation program with mothers who did not receive ART. We also determine the modifiable risk factors associated with an increased risk of perinatal HIV transmission. Identification of the factors likely to increase the risk of perinatal transmission of HIV is important in enhancing the therapeutic effect of ARV therapy.Single dose nevirapine and a short course of zidovudine (AZT) are now administered in most hospitals in Adamawa State, Nigeria to prevent mother-to-child transmission (MTCT) of HIV. The effectiveness of these antiretroviral (ARV) regimens has been shown in the clinical trials but has not been demonstrated outside the clinical trials setting in this country. The epidemiological trend of human immunodeficiency virus (HIV) in 2016 is encouraging, with the decline of death from HIV/AIDS by 40% since 2000 [1, 2]. According to the UNAIDS global report at the end of 2014, 36.9 million people were living with HIV, 2 million people were newly infected, and 1.2 million had died from HIV related causes. Since 1990, this is the lowest number of new infections that the world has experienced in 20 years. Most importantly, the numbers of 15-24 years olds that are acquiring HIV infection have declined from 980,000 (930,000- 1,020,000) in 2000 to 620,000 in 2014 [1]. This decline is largely attributed to Sub Saharan Africa (SSA) where 41% reduction was seen in new HIV infections from 2000-2014.
