Author(s)

Alfred A. Kamuyango, Lisa R. Hirschhorn, Wenjia Wang, Perry Jansen, Risa M. Hoffman

Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.
Department of Medicine and Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, USA.
Department of Pathology, College of Medicine, University of Malawi, Blantyre, Malawi.
Department of Statistics, University of California, Los Angeles, USA.
Hope Medical Centre, Lilongwe, Malawi.

Objective: To compare one-year outcomes of women started on antiretroviral therapy (ART) during pregnancy in the pre-Option B+ era to those in the Option B+ era. Methods: A retrospective chart review was performed at three sites in Malawi. Women were included in the “pre-Option B+” cohort if they started ART during pregnancy for a CD4 count < 350 cells/mm³ or WHO 3/4 condition and in the “Option B+” cohort if they started ART during pregnancy regardless of CD4 count or clinical stage. One-year outcomes were compared using Fisher’s exact and ANOVA F-tests. Results: A higher proportion of women in the pre-Option B+ cohort started ART at WHO stage 3/4 (11.9% versus 1.1%, P < 0.001), switched ART regimens (5.9% versus 0%, P = 0.002), or died in the first year after starting treatment (3.9% versus 0.5%, P = 0.05). While more women in the Option B+ cohort had poor adherence or defaulted, these differences were not significant. Conclusions: At our study sites, the transition to Option B+ has been associated with ART initiation in women with less advanced HIV infection, improved medication tolerability, and lower mortality. Further research is needed to better understand outcomes of Option B+.

Antiretroviral Therapy, Pregnancy, Option B+, Prevention of Mother-to-Child Transmission

Kamuyango, A. , Hirschhorn, L. , Wang, W. , Jansen, P. and Hoffman, R. (2014) One-Year Outcomes of Women Started on Antiretroviral Therapy during Pregnancy before and after the Implementation of Option B+ in Malawi: A Retrospective Chart Review from Three Facilities. World Journal of AIDS, 4, 332-337. doi: 10.4236/wja.2014.43039.