Effect of mother to child transmission intervention strategies and clinical, hematological, immunological characteristics in children born to HIV-1 infected mothers in India

We evaluated the effect of interventions for preventing mother to child transmission (MTCT) of human immunodeficiency virus type 1 (HIV-1) infection and studied the effect of highly active antiretroviral therapy (HAART) on clinical, hematological and immunological characteristics in a cohort of HIV-1 seropositive infants. We included 399 HIV exposed infants from July 2002 to October 2008. Of these, 49 infants received MTCT prophylaxis (intervention group); while 350 infants were born to mothers received no prophylactic measures and comprised the non-intervention group. DNA polymerase chain reaction was done to confirm the HIV status before 18 months and enzyme-linked immunosorbent assay (ELISA) beyond 18 months of age. Children found to be HIV-1 positive were started on anti retroviral treatment (ART) as per guidelines, and followed up after 10 months interval. Hemoglobin levels and CD4 counts were also recorded at each visit. A significant difference was observed in MTCT rates between intervention and non-intervention groups (P=0.001). Antiretroviral therapy was started for 23 of the 94 HIV-1 infected children after recording baseline clinical, hematological and immunological parameters. Hemoglobin levels increased significantly after initiation of HAART (pre vs. months post zidovudine: P=0.002). The CD4 counts, CD4% and CD4/CD8 ratio improved significantly post therapy in all children. (P=0.0001, P=0.0001, and P=0.0001 respectively). Identification of maternal HIV infection at an early stage is important to maximize option and allow optimal timing of therapeutic strategies to prevent MTCT of HIV-1 infection. The early use of HAART improves clinical, hematological and immunological characteristics, delays the progression of disease and improves survival in HIV-1-infected children.