Option B+ and HIV Infection Among Antenatal Patients
Option B+ and HIV Infection Among Antenatal Patients
As countries consider a wider use of triple antiretroviral therapy (ART) in pregnancy, which in recent World Health Organization guidelines is called Option B+, this study sought to explore the potential implications of adopting Option B+ by characterizing HIV infection in pregnant women attending 2 semiurban antenatal clinics in Cameroon. In a descriptive cross-sectional study, consenting women were screened for HIV; positive samples were confirmed using an enzyme-linked immunosorbent assay test, and CD4 levels and HIV viral loads were determined using flow cytometry and reverse transcription–polymerase chain reaction, respectively. The seroprevalence of HIV in the 407 pregnant women screened was 8.4% (95% confidence interval: 5.9%-11.5%). The majority (82.4%) of HIV-positive women had CD4 counts >350 cells/mm. A quarter (25%) had undetectable viral levels (<80 copies/mL). Adopting Option B+ in this setting would result in a 5-fold increase in the number of HIV-infected pregnant women being placed on lifelong triple ART.
In 2010, the World Health Organization (WHO) published revised guidelines on the management of HIV in adults (including pregnant women) and adolescents, as well as on the prevention of mother-to-child transmission (PMTCT) of HIV infection. The 2010 revised guidelines for PMTCT of HIV infection recommended 2 options for antiretroviral (ARV) prophylaxis in pregnant women: Option A (ARV prophylaxis for HIV-infected pregnant women with CD4 counts >350 cells/mm) and Option B (antiretroviral therapy [ART] for those with CD4 counts ≤350 cells/mm).
Despite significant efforts that the international community has made toward reducing the cost of ARVs, a recent update published in 2012 by the WHO estimated that Option B was about 2 to 5 times more costly than Option A, explaining why Option A has been adopted by many resource-limited countries. Recent developments in the field of PMTCT have led to the advent of a new third option (Option B+) that advocates the maternal administration of ART for life irrespective of the CD4 counts. There is now a global advocacy and trend toward the universal adoption of Option B+ to meet the changes in the context and expectations of PMTCT programs such as the goals to eliminate pediatric HIV infections, new evidence to support ARV treatment as HIV prevention, and the decreasing cost of ARV drugs, among others.
Although the prevalence of HIV in Cameroon has significantly decreased over the years, by the end of 2012 HIV still remained a major public health problem with current prevalence rates of 4.3% and 7.9% in the general population and in pregnant women, respectively. With the constantly changing epidemiology of the HIV infection and with Option B+ being considered for adoption in Cameroon, we conducted this study to understand the prevalence and characteristics of maternal HIV infection, which are crucial in supplying adequate information with respect to the shift to Option B+ in our context. Since many pregnant women in our context are likely to have been infected around the period of conception or during the course of the current pregnancy, we hypothesized that the CD4 counts in this group of pregnant women would be greater than 350 cells/mm.
Abstract and Introduction
Abstract
As countries consider a wider use of triple antiretroviral therapy (ART) in pregnancy, which in recent World Health Organization guidelines is called Option B+, this study sought to explore the potential implications of adopting Option B+ by characterizing HIV infection in pregnant women attending 2 semiurban antenatal clinics in Cameroon. In a descriptive cross-sectional study, consenting women were screened for HIV; positive samples were confirmed using an enzyme-linked immunosorbent assay test, and CD4 levels and HIV viral loads were determined using flow cytometry and reverse transcription–polymerase chain reaction, respectively. The seroprevalence of HIV in the 407 pregnant women screened was 8.4% (95% confidence interval: 5.9%-11.5%). The majority (82.4%) of HIV-positive women had CD4 counts >350 cells/mm. A quarter (25%) had undetectable viral levels (<80 copies/mL). Adopting Option B+ in this setting would result in a 5-fold increase in the number of HIV-infected pregnant women being placed on lifelong triple ART.
Introduction
In 2010, the World Health Organization (WHO) published revised guidelines on the management of HIV in adults (including pregnant women) and adolescents, as well as on the prevention of mother-to-child transmission (PMTCT) of HIV infection. The 2010 revised guidelines for PMTCT of HIV infection recommended 2 options for antiretroviral (ARV) prophylaxis in pregnant women: Option A (ARV prophylaxis for HIV-infected pregnant women with CD4 counts >350 cells/mm) and Option B (antiretroviral therapy [ART] for those with CD4 counts ≤350 cells/mm).
Despite significant efforts that the international community has made toward reducing the cost of ARVs, a recent update published in 2012 by the WHO estimated that Option B was about 2 to 5 times more costly than Option A, explaining why Option A has been adopted by many resource-limited countries. Recent developments in the field of PMTCT have led to the advent of a new third option (Option B+) that advocates the maternal administration of ART for life irrespective of the CD4 counts. There is now a global advocacy and trend toward the universal adoption of Option B+ to meet the changes in the context and expectations of PMTCT programs such as the goals to eliminate pediatric HIV infections, new evidence to support ARV treatment as HIV prevention, and the decreasing cost of ARV drugs, among others.
Although the prevalence of HIV in Cameroon has significantly decreased over the years, by the end of 2012 HIV still remained a major public health problem with current prevalence rates of 4.3% and 7.9% in the general population and in pregnant women, respectively. With the constantly changing epidemiology of the HIV infection and with Option B+ being considered for adoption in Cameroon, we conducted this study to understand the prevalence and characteristics of maternal HIV infection, which are crucial in supplying adequate information with respect to the shift to Option B+ in our context. Since many pregnant women in our context are likely to have been infected around the period of conception or during the course of the current pregnancy, we hypothesized that the CD4 counts in this group of pregnant women would be greater than 350 cells/mm.
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