Temporal changes in the outcomes of HIV-exposed infants in Kinshasa, Democratic Republic of Congo during a period of rapidly evolving guidelines for care (2007-2013)

Feinstein, Lydia; Edmonds, Andrew; Chalachala, Jean Lambert; Okitolonda, Vitus; Lusiama, Jean; Van Rie, Annelies; Chi, Benjamin H.; Cole, Stephen R.; Behets, Frieda

doi:10.1097/QAD.0000000000000331

Title

Temporal changes in the outcomes of HIV-exposed infants in Kinshasa, Democratic Republic of Congo during a period of rapidly evolving guidelines for care (2007-2013)

Author

Feinstein, Lydia

Edmonds, Andrew

Chalachala, Jean Lambert

Okitolonda, Vitus

Lusiama, Jean

Van Rie, Annelies

Chi, Benjamin H.

Cole, Stephen R.

Behets, Frieda

Abstract

Objective:Guidelines for prevention of mother-to-child transmission of HIV have developed rapidly, yet little is known about how outcomes of HIV-exposed infants have changed over time. We describe HIV-exposed infant outcomes in Kinshasa, Democratic Republic of Congo, between 2007 and 2013.Design:Cohort study of mother-infant pairs enrolled in family-centered comprehensive HIV care.Methods:Accounting for competing risks, we estimated the cumulative incidences of early infant diagnosis, HIV transmission, death, loss to follow-up, and combination antiretroviral therapy (cART) initiation for infants enrolled in three periods (2007-2008, 2009-2010, and 2011-2012).Results:1707 HIV-exposed infants enrolled at a median age of 2.6 weeks. Among infants whose mothers had recently enrolled into HIV care (N=1411), access to EID by age two months increased from 28% (95% confidence limits [CL]: 24,34%) among infants enrolled in 2007-2008 to 63% (95% CL: 59,68%) among infants enrolled in 2011-2012 (Gray's p-value <0.01). The 18-month cumulative incidence of HIV declined from 16% (95% CL: 11,22%) for infants enrolled in 2007-2008 to 11% (95% CL: 8,16%) for infants enrolled in 2011-2012 (Gray's p-value = 0.19). The 18-month cumulative incidence of death also declined, from 8% (95% CL: 5,12%) to 3% (95% CL: 2,5%) (Gray's p-value = 0.02). LTFU did not improve, with 18-month cumulative incidences of 19% (95% CL: 15,23%) for infants enrolled in 2007-2008 and 22% (95% CL: 18,26%) for infants enrolled in 2011-2012 (Gray's p-value = 0.06). Among HIV-infected infants, the 24-month cumulative incidence of cART increased from 61% (95% CL: 43,75%) to 97% (95% CL: 82,100%) (Gray's p-value <0.01); the median age at cART decreased from 17.9 to 9.3 months. Outcomes were better for infants whose mothers enrolled before pregnancy.Conclusions:We observed encouraging improvements, but continued efforts are needed.

Language

English

Source (journal)

AIDS. - London

Publication

London : 2014

ISSN

0269-9370

DOI

10.1097/QAD.0000000000000331

Volume/pages

28 :s:[3] (2014) , p. S301-S311