Effect of mother to child transmission intervention strategies and
clinical, hematological, immunological characteristics in children born to
HIV-1 infected mothers in India
Affiliations: Department of Microbiology, All India Institute of
Medical Sciences, Ansari Nagar, New Delhi, India
Note: [] Correspondence: Dr. Madhu Vajpayee, HIV & Immunology
Division, Department of Microbiology, All India Institute of Medical Sciences,
Ansari Nagar, New Delhi-110029. Tel.: +91 11 26593288; Fax: +91 11 26588641;
E-mail: mvajpayee@hotmail.com; vajpayee@gmail.com
Abstract: 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.
Keywords: HIV-1, MTCT, children, HAART, hemoglobin, CD4 count, India
