South Africa's PMTCT program showing dramatic results in HIV-positive women

The percentage of HIV-positive mothers who pass the virus to their newborn babies in South Africa's KwaZulu-Natal Province has dropped by nearly two-thirds since dual antiretroviral (ARV) therapy was introduced for the prevention of mother-to-child transmission (PMTCT), reports the local Plus News.

Prior to the nation's Department of Health switching to dual therapy in January 2008, pregnant women testing HIV positive were given a single dose of the ARV drug, nevirapine, during labor, and their babies received a dose when they were born. However, a 2005 study found that, on the nevirapine-only regimen, one in five HIV-positive mothers were still transmitting the virus to their infants.

With dual therapy, HIV-positive women started receiving the ARV drug, zidovudine (AZT), from 28 weeks of pregnancy, as well as a single dose of nevirapine. Their babies received AZT for seven days after birth, and a dose of nevirapine.

The study started in May 2008, which was only eight weeks after AZT was introduced, so it was actually quite a rapid rollout," said Dr Christiane Horwood, lead investigator and deputy head of the Center for Rural Health at the University of KwaZulu-Natal. "We spend a lot of time moaning about the [public] health service, but I think this really shows an incredibly impressive effort," she added.

As South Africa's PMTCT guidelines stipulate that pregnant women should be tested for HIV during their first visit to an antenatal facility, Dr Horwood surmised that many women started using antenatal services very late in their pregnancies.

Of the 36% of women in the study who tested HIV-positive, only 65% received results from CD4 count tests, a measure of immune system strength essential for determining readiness to start ARV therapy. The government recently announced that all pregnant HIV-positive women with CD4 counts at or below 350 would qualify for ARVs, but at the time of the study the CD4 threshold for starting treatment was still 200.

South Africa's maternal mortality rate has remained stubbornly high, partly because of the number of women with low CD4 counts who die during childbirth; they are also more likely to transmit HIV to their babies, a factor keeping the infant mortality rate high, says Plus News.

Two-thirds of women in the study who tested positive received dual therapy, 14% received nevirapine only, and 13% started ARV treatment. The researchers took blood samples from 8,013 babies aged between four weeks and eight weeks at immunization clinics, and found that of those whose mothers had received dual therapy, 5.6% were HIV-positive compared to 13.5% of babies whose mothers only received nevirapine.