Effects of preterm birth, maternal ART and breastfeeding on 24-month infant HIV-free survival in a randomized trial.

Journal

AIDS (London, England)
ISSN: 1473-5571
Titre abrégé: AIDS
Pays: England
ID NLM: 8710219

Informations de publication

Date de publication:
04 Mar 2024
Historique:
medline: 1 3 2024
pubmed: 1 3 2024
entrez: 1 3 2024
Statut: aheadofprint

Résumé

IMPAACT 1077BF/FF compared the safety/efficacy of two HIV antiretroviral therapy (ART) regimens to zidovudine (ZDV) alone during pregnancy for HIV prevention. PROMISE found an increased risk of preterm delivery (<37 weeks) with antepartum triple ART (TDF/FTC/LPV+r or ZDV/3TC/LPV+r) compared to ZDV alone. We assessed the impact of preterm birth, breastfeeding and antepartum ART regimen on 24-month infant survival. We compared HIV-free and overall survival at 24-months for liveborn infants by gestational age, time-varying breastfeeding status, and antepartum ART arm at 14 sites in Africa and India. Kaplan-Meier survival probabilities and Cox proportional hazards ratios (HR) were estimated. 3,482 live-born infants (568 [16 3%] preterm and 2,914 [83 7%] term) were included. Preterm birth was significantly associated with lower HIV-free survival (0·85; 95% CI: 0·82-0·88) and lower overall survival (0·89; 95% CI: 0·86-0·91) versus term birth (0·96; 95% CI: 0·95-0·96). Very preterm birth (<34 weeks) was associated with low HIV-free survival (0·65; 95% CI: 0·54-0·73) and low overall survival (0·66; 95% CI: 0·56-0·74). Risk of HIV infection or death at 24-months was higher with TDF-ART than ZDV-ART (adjusted HR 2·37; 95% CI: 1·21-4·64). Breastfeeding initiated near birth decreased risk of infection or death at 24 months (adjusted HR 0·05; 95% CI: 0·03-0·08) compared to not breastfeeding. Preterm birth and antepartum TDF-ART were associated with lower 24-month HIV-free survival compared to term birth and ZDV-ART. Any breastfeeding strongly promoted HIV-free survival, especially if initiated close to birth. Reducing preterm birth and promoting infant feeding with breastmilk among HIV/ARV-exposed infants remain global health priorities.

Sections du résumé

BACKGROUND BACKGROUND
IMPAACT 1077BF/FF compared the safety/efficacy of two HIV antiretroviral therapy (ART) regimens to zidovudine (ZDV) alone during pregnancy for HIV prevention. PROMISE found an increased risk of preterm delivery (<37 weeks) with antepartum triple ART (TDF/FTC/LPV+r or ZDV/3TC/LPV+r) compared to ZDV alone. We assessed the impact of preterm birth, breastfeeding and antepartum ART regimen on 24-month infant survival.
METHODS METHODS
We compared HIV-free and overall survival at 24-months for liveborn infants by gestational age, time-varying breastfeeding status, and antepartum ART arm at 14 sites in Africa and India. Kaplan-Meier survival probabilities and Cox proportional hazards ratios (HR) were estimated.
RESULTS RESULTS
3,482 live-born infants (568 [16 3%] preterm and 2,914 [83 7%] term) were included. Preterm birth was significantly associated with lower HIV-free survival (0·85; 95% CI: 0·82-0·88) and lower overall survival (0·89; 95% CI: 0·86-0·91) versus term birth (0·96; 95% CI: 0·95-0·96). Very preterm birth (<34 weeks) was associated with low HIV-free survival (0·65; 95% CI: 0·54-0·73) and low overall survival (0·66; 95% CI: 0·56-0·74). Risk of HIV infection or death at 24-months was higher with TDF-ART than ZDV-ART (adjusted HR 2·37; 95% CI: 1·21-4·64). Breastfeeding initiated near birth decreased risk of infection or death at 24 months (adjusted HR 0·05; 95% CI: 0·03-0·08) compared to not breastfeeding.
CONCLUSION CONCLUSIONS
Preterm birth and antepartum TDF-ART were associated with lower 24-month HIV-free survival compared to term birth and ZDV-ART. Any breastfeeding strongly promoted HIV-free survival, especially if initiated close to birth. Reducing preterm birth and promoting infant feeding with breastmilk among HIV/ARV-exposed infants remain global health priorities.

Identifiants

DOI: 10.1097/QAD.0000000000003878 PMID: 38427596
pubmed: 38427596
doi: 10.1097/QAD.0000000000003878
pii: 00002030-990000000-00457
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.

Auteurs

Sufia Dadabhai (S)

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; 615 N. Wolfe Street, Baltimore, MD 21205, USA.
Kamuzu University of Health Sciences-Johns Hopkins Research Project; P.O. Box 1131, Blantyre, Malawi.

Victoria B Chou (VB)

Department of Pathology, Johns Hopkins University School of Medicine; 600 N. Wolfe Street, Baltimore, MD 21287, USA.

Mauricio Pinilla (M)

Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health; 677 Huntington Avenue, Boston, MA 02115, USA.

Lameck Chinula (L)

Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA and University of North Carolina Project Malawi, Tidziwe Centre, 100 Mzimba Road, Lilongwe, Malawi.

Maxensia Owor (M)

MU-JHU Research Collaboration; Upper Mulago Hill Road, P.O. Box 23491, Kampala, Uganda.

Avy Violari (A)

Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, South Africa.

Dhayendre Moodley (D)

Centre for the AIDS Programme of Research in South Africa and School of Clinical Medicine, University of KwaZulu Natal; Private Bag X7, Congella, 4013, South Africa.

Lynda Stranix-Chibanda (L)

Child, Adolescent and Women's Health Department, Faculty of Medicine and Health Sciences, University of Zimbabwe; P.O. Box A178, Avondale, Harare, Zimbabwe.
University of Zimbabwe Clinical Trials Research Centre; 15 Phillips Avenue, Belgravia, Harare, Zimbabwe.

Taguma Allen Matubu (TA)

University of Zimbabwe Clinical Trials Research Centre; 15 Phillips Avenue, Belgravia, Harare, Zimbabwe.

Gift Tafadzwa Chareka (GT)

University of Zimbabwe Clinical Trials Research Centre; 15 Phillips Avenue, Belgravia, Harare, Zimbabwe.

Gerhard Theron (G)

Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.

Aarti Avinash Kinikar (AA)

B.J. Government Medical College, Department of Paediatrics, Pune, India.

Mwangelwa Mubiana-Mbewe (M)

Centre for Infectious Disease Research in Zambia, George CRS, P.O. BOX 34681, Lusaka, Zambia.

Lee Fairlie (L)

Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Raziya Bobat (R)

Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa.

Blandina Theophil Mmbaga (BT)

Kilimanjaro Christian Medical Centre, Kilimanjaro Clinical Research Institute and Kilimanjaro Christian Medical University College/Kilimanjaro CRS, Box 3010, Moshi, Tanzania.

Patricia M Flynn (PM)

St. Jude Children's Research Hospital; 262 Danny Thomas Place, Memphis, TN, USA 38105, USA.

Taha E Taha (TE)

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; 615 N. Wolfe Street, Baltimore, MD 21205, USA.

Katie S McCarthy (KS)

FHI 360; 359 Blackwell Street, Suite 200, Durham, NC 27701, USA.

Renee Browning (R)

National Institute of Allergy and Infectious Diseases/NIH, Fishers Lane, Rockville, MD 20852, USA.

Lynne M Mofenson (LM)

Elizabeth Glaser Pediatric AIDS Foundation, 1350 Eye Street, Suite 400, Washington DC 20005, USA.

Sean S Brummel (SS)

Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health; 677 Huntington Avenue, Boston, MA 02115, USA.

Mary Glenn Fowler (MG)

Department of Pathology, Johns Hopkins University School of Medicine; 600 N. Wolfe Street, Baltimore, MD 21287, USA.

Classifications MeSH