Option B+ and HIV Infection Among Antenatal Patients
Option B+ and HIV Infection Among Antenatal Patients
In this study, we find that the prevalence of HIV in pregnancy remains high in antenatal clinics in Buea, Cameroon. Furthermore, although a vast majority had CD4 counts >350 cells/mm, the viral load levels remained high, suggesting a considerable risk of transmission to their infants if these women did not receive ARV regimens. Our findings were similar to other reports from sub-Saharan countries, which showed that the prevalence of HIV among pregnant women is still high despite the efforts that are being made to prevent new infections. Pregnant women who were married, employed, or had completed at least secondary school education were most likely to be HIV positive. However, our findings indicated that the prevalence of HIV among pregnant women in Buea has shown a significant drop since the last estimate in 2002. Our findings also revealed that the majority of the sero-positive participants were infected with HIV-1, a similar finding from other reports in Cameroon, which demonstrated that HIV-1 is the predominant type in the country.
The mean CD4 count of 546 (±179) cells/mm was similar to those obtained from studies in Yaoundé, Cameroon, and North-Rift, Kenya. The relatively high mean CD4 count in the majority of the sero-positive participants may be indicative of recent HIV infection. Most of the HIV-infected participants had CD4 counts >350 cells/mm, which confirmed our hypothesis. According to the WHO 2010 guidelines for ARV prophylaxis in pregnancy, these sero-positive participants would be eligible for ARV prophylaxis with either Option A or B. However, with Option B+, all HIV-sero-positive pregnant women would be placed on lifelong ART. If this is true, this will certainly demand a significant increase in financial resources for the provision of combinational ART, especially in a resource-limited country like Cameroon, where over 60% of all the funding for the fight against HIV was from international donors.
The mean viral load (at log10 4.4 copies/mL) was similar to that reported by Njom Nlend in 2011 in Yaoundé. We found that 7 of 10 sero-positive pregnant women who were on ARVs before enrollment were experiencing virological failure. This finding poses a significant obstacle in the management of sero-positive pregnant women, especially as viral load testing still remains a scarce and expensive laboratory examination in this part of the world.
These findings are confined to a sample of semiurban pregnant women who attended ANC clinics in 2 health facilities, thus limiting their generalizability to the whole of Cameroon. Moreover, participants who could have been in seroconversion may have been missed out because only sero-positive samples were tested for the presence of viral RNA by the PCR technique for viral load determination.
Discussion
In this study, we find that the prevalence of HIV in pregnancy remains high in antenatal clinics in Buea, Cameroon. Furthermore, although a vast majority had CD4 counts >350 cells/mm, the viral load levels remained high, suggesting a considerable risk of transmission to their infants if these women did not receive ARV regimens. Our findings were similar to other reports from sub-Saharan countries, which showed that the prevalence of HIV among pregnant women is still high despite the efforts that are being made to prevent new infections. Pregnant women who were married, employed, or had completed at least secondary school education were most likely to be HIV positive. However, our findings indicated that the prevalence of HIV among pregnant women in Buea has shown a significant drop since the last estimate in 2002. Our findings also revealed that the majority of the sero-positive participants were infected with HIV-1, a similar finding from other reports in Cameroon, which demonstrated that HIV-1 is the predominant type in the country.
The mean CD4 count of 546 (±179) cells/mm was similar to those obtained from studies in Yaoundé, Cameroon, and North-Rift, Kenya. The relatively high mean CD4 count in the majority of the sero-positive participants may be indicative of recent HIV infection. Most of the HIV-infected participants had CD4 counts >350 cells/mm, which confirmed our hypothesis. According to the WHO 2010 guidelines for ARV prophylaxis in pregnancy, these sero-positive participants would be eligible for ARV prophylaxis with either Option A or B. However, with Option B+, all HIV-sero-positive pregnant women would be placed on lifelong ART. If this is true, this will certainly demand a significant increase in financial resources for the provision of combinational ART, especially in a resource-limited country like Cameroon, where over 60% of all the funding for the fight against HIV was from international donors.
The mean viral load (at log10 4.4 copies/mL) was similar to that reported by Njom Nlend in 2011 in Yaoundé. We found that 7 of 10 sero-positive pregnant women who were on ARVs before enrollment were experiencing virological failure. This finding poses a significant obstacle in the management of sero-positive pregnant women, especially as viral load testing still remains a scarce and expensive laboratory examination in this part of the world.
These findings are confined to a sample of semiurban pregnant women who attended ANC clinics in 2 health facilities, thus limiting their generalizability to the whole of Cameroon. Moreover, participants who could have been in seroconversion may have been missed out because only sero-positive samples were tested for the presence of viral RNA by the PCR technique for viral load determination.
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