Mother-to-child transmission of HIV-1 and infant mortality in the first six months of life, in the era of Option B Plus combination antiretroviral therapy

Objectives: The aim of this study was to determine the contributions of intrauterine (IU), intrapartum (IP), and postpartum (PP) transmission to mother-to-child transmission of HIV-1 (MTCT) and infant mortality in the first 6 months of life, in the era of Option B Plus combination antiretroviral therapy.

Methods: Plasma for virus load (VL) quantitation was obtained from 451 women enrolled into the study. VL was quantified using the Cepheid GeneXpert HIV-1 quantitative test. Dried blood spots were collected from 453 infants at birth, 4-6 weeks, 3 months, and 6 months. HIV-1 infant diagnosis was conducted using the Cepheid GeneXpert HIV-1 qualitative test. Absolute and cumulative MTCT rates, and the mortality rate by 6 months were calculated.

Results: Seven mothers (1.55%) had transmitted HIV-1 infection to their infants by 6 months. Four infants (0.88%, 95% confidence interval (CI) 0.26-2.33%) were infected IU, one infant (0.22%, 95% CI 0-1.4%) was infected IP, and two infants (0.44%, 95% CI 0.01-1.7%) were infected PP. The infant mortality rate was 0.88% (95% CI 0.26-2.33%).

Conclusions: In the first 6 months of life, in the era of Option B Plus combination antiretroviral therapy, IU transmission is the major route of MTCT. The cumulative MTCT rate of 1.55% in a breastfeeding population contributes to growing evidence that complete elimination of MTCT is possible.