Low rate of early vertical transmission of HIV supports the feasibility of effective implementation of the national PMTCT guidelines in routine practice of referral hospitals in Cameroon

ABSTRACT

Background: Vertical (VT) transmission of HIV remains a public health concern in sub-Saharan Africa.

Objective: To investigate the VT rate and factors associated with transmission in routine practice in three referral hospitals in Cameroon.

Methods: All HIV-infected mothers who delivered in maternity wards or sought paediatric services during the first postnatal week from November 2007 to October 2010 were invited to participate in the ANRS-Pediacam cohort. Their infants were followed at 6, 10 and 14 weeks of life and HIV status was determined from the 6th week of life using real-time PCR. For those who were breastfed and negative at the first PCR, a second test was performed 6 weeks after breast-feeding was stopped. Logistic regression was performed to identify the independent risk factors of VT.

Results: Overall, 2053 HIV-exposed infants were enrolled. Of these, 1827 were tested for HIV including 1777 before the age of 3 months, and 59 were HIV-infected, resulting in an overall early VT rate of 3.3% (CI 2.5–4.3). The VT rate was significantly associated with the type of maternal exposure to ART (0.5%, 2/439, p<0.001, CI 0.0-1.6) in mothers who commenced HAART before pregnancy, 1.9% (6/321, CI 0.7–4.0) in mothers who commenced HAART during pregnancy, 4.1% (34/837, CI 2.8–5.6) in those on short-course ART and 11.1% (17/153, CI 6.6–17.2) in mothers not receiving ART. On multivariate analysis, the type of exposure to ART remained significantly associated with being small for gestational age (aOR 5.0, CI 2.4–10.3, p < 0.001) and female gender (aOR 2.1, CI 1.2–3.8, p = 0.01).

Conclusion: The successfully low rate of VT transmission of HIV in mothers who commenced HAART in early pregnancy strongly supports the need to improve access to diagnosis and early treatment of all women of childbearing age with HIV through the national PMTCT programme.

Abbreviations: ANRS: French National Agency for Research on AIDS and Viral Hepatitis; ART: antiretroviral therapy; ARV: antiretroviral; AUDIPOG: Association des Utilisateurs de Dossiers Informatisés en Pédiatrie, Obstétrique et Gynécologie; CHM/MCC-CBF: The Central Hospital Maternity/Mother and Child Centre of the Chantal Biya Foundation; EHC: Essos Hospital Centre; EPI: Expanded Programme on Immunization; HAART: highly active antiretroviral therapy; HBV: hepatitis B virus; IQR: interquartile range; LH: Laquintinie Hospital; MTCT: mother-to-child transmission; NVP: nevirapine; Pediacam: Pediatrie Cameroun; PMTCT: prevention of mother-to-child transmission; SGAG: small for gestational age and gender; UNAIDS: Joint United Nations Program on HIV/AIDS; WHO: World Health Organization; ZDV: zidovudine; 3TC: lamivudine.

KEYWORDS:

• PMTCT
• early HIV diagnosis
• VT rate
• VT risk factors
• Cameroon

Acknowledgments

We are particularly grateful to the parents who agreed to their infants’ inclusion in the study. We thank the entire ANRS-Pediacam study team for their commitment and excellent collaboration. Our appreciation is also extended to the institutions that contributed to the conduct of the study, particularly the Cameroon Ministry of Public Health, the National Ethics Committee, the Association of People Living with HIV/AIDS, the Pasteur Centre of Cameroun, the Central Hospital Maternity, the Mother and Child Centre of the Chantal Biya Foundation and the Essos Hospital Centre in Yaoundé, Laquintinie Hospital in Douala, the Total Foundation. We acknowledge the French National Agency for Research on AIDS and Viral Hepatitis for funding the study.

Availability of data and materials

Because of the ongoing nature of the cohort, the data analysed in the current study are not in the public domain but are available from the corresponding author upon reasonable request.

Authors’ contributions

CIP, MCT, JW, AK and AF designed the study. MCT, AF and JW coordinated the study. CIP, STN, GG and FAN recruited and followed the children and collected the data. MCT and CLS managed the data and performed the statistical analysis. MCT, CLS, AF, JW and CIP interpreted the study data. CIP, CLS and MCT wrote the first draft and all authors reviewed the manuscript and approved the final version.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The ANRS 12140 – PEDIACAM study was sponsored by the French National Agency for Research on AIDS and Viral Hepatitis in France (ANRS). The funder had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.

Notes on contributors

Calixte Ida Penda

*Dr Calixte Ida Penda (MD,MPH) in an Pediatrician, a public health physician and senior lecturer at Faculty of medicine and pharmaceutical sciences, University of Douala. Currently Head of Department of pediatrics and Coordinator of Day Hospital (Treatment Centre for Adults and Children Living with HIV)  at Douala Laquintinie Hospital (DLH), investigator of the Pediacam project ANRS 12140 from the DLH site.

Mathurin Cyrille Tejiokem

Dr Mathurin Cyrille Tejiokem (MD, MPH, PhD) is an epidemiologist, a public health physician and a senior researcher working at the Centre Pasteur of Cameroon. He is currently the Head of Epidemiology and Public Health Unit.

Casimir Ledoux Sofeu

Casimir Ledoux Sofeu (Msc, MPH) was formally working at Centre Pasteur of Cameroun as Data manager within the Pediacam cohort research team. He is now a PhD-student at The University of Bordeaux.

Suzie Tetang Ndiang

Dr Suzie Tetang Ndiang (MD) is a pediatrician working at the Essos Hospital Center, a reference hospital in Yaounde. She is currently the head of the Pediatric unit.

Francis Ateba Ndongo

Dr Ateba Ndongo Francis (MD, MPH, PhD) is an epidemiologist currently the head of the day care unit at the Mother Child Center of the Chantal Biya Foundation in Yaounde.

Anfumbom Kfutwah

Dr Anfumbom Kfutwah (PhD) is a virologist formerly Head of the HIV laboratory at Centre Pasteur of Cameroon. He recently joint the World Health organization regional team based in Libreville Gabon.

Georgette Guemkam

Dr Guemkam Georgette (MD) is a pediatrician specialized in nephrology working at the Mother Child Center of the Chantal Biya Foundation in Yaounde.

Josiane Warszawski

Dr Josiane Warszawski (MD, MPH, PhD) is an epidemiologist currently coordinating the French Perinatal Cohort (EPF), a multicenter prospective cohort of HIV-infected pregnant women and their children within the French National Institute of Health and Medical Research unit 1018.

Albert Faye

Prof. Albert Faye (MD, PhD) is a full professor of pediatric. He is currently the Head of the pediatric unit at Robert Debre Hospital in Paris, France. He is also a team member of the French National Institute of Health and Medical Research unit 1123.