A Systematic Review to Explore the Factors Related to Parent to Child Transmission of HIV, Survival and Treatment Provision of Children with HIV in India


Introduction: There are a multitude of factors that impact the transmission of HIV from parent to child and the subsequent survival of infected children. Changing dynamics in HIV transmission have led to an increase in the number of children living with HIV in India. This review synthesizes the evidence related to transmission of HIV to children, survival and treatment provision among children living with HIV. Methods: A systematic search was conducted in MEDLINE, IndMed, Web of Science, Google Scholar and major journals related to HIV/AIDS to identify relevant studies published between 1992 and 2015. Inclusion criteria included studies related to parent to child transmission of HIV, treatment of children living with HIV and survival of children living with HIV. One of the authors reviewed the studies and extracted the data in a pre-coded extraction sheet. Results: Thirty-three studies were included in the review. HIV transmission rate from parent to Child who received nevirapine prophylaxis ranged from 2.1% to 27.3%. Extended dose regimen of nevirapine prophylaxis was found to be more effective than the single dose regimen. Adherence to ART ranged from 65% to 95%. Adherence varied depending upon the level of health care facility. Both social and medical factors were associated with non-adherence. CD 4 count at the time of diagnosis and delayed age at HIV diagnosis were important predictors of survival. Conclusion: Shift in policy to provide option B regimen is yielding better results. If the age at diagnosis could be reduced further, it would increase the survival of children living with HIV. The program needs to increase access to the health care facilities.

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Singh, A. , Haldar, P. , Rai, S. and Kant, S. (2015) A Systematic Review to Explore the Factors Related to Parent to Child Transmission of HIV, Survival and Treatment Provision of Children with HIV in India. World Journal of AIDS, 5, 245-255. doi: 10.4236/wja.2015.53028.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] National AIDS Control Organisation (2015) Annual Report 2013-2014. Department of AIDS Control Ministry of Health and Family Welfare Government of India, New Delhi.
[2] Pandey, A., Sahu, D., Bakkali, T., Reddy, D., Venkatesh, S. and Kant, S. (2012) Estimate of HIV Prevalence and Number of People Living with HIV in India 2008-2009. BMJ Open, 2, 5.
[3] National AIDS Control Organisation (2013) Updated Guidelines for Prevention of Parent to Child Transmission (PPTCT) of HIV Using Multi Drug Ante Retroviral Regimen in India.
[4] UNAIDS (2013) UNAIDS Report on the Global AIDS Epidemic.
[5] World Health Organization (2013) Consolidated Guidelines on the Use of Anteretroviral Drugs for Treating and Preventing HIV Infection. http://www.who.int/hiv/pub/guidelines/arv2013/en/
[6] Darak, S., Panditrao, M., Parchure, R., Kulkarni, V., Kulkarni, S. and Janssen, F. (2012) Systematic Review of Public Health Research on Prevention of Mother-to-Child Transmission of HIV in India with Focus on Provision and Utilization of Cascade of PMTCT Services. BMC Public Health, 12, 320.
[7] Alvarez-Uria, G., Midde, M., Pakam, R., Bachu, L. and Naik, P.K. (2012) Effect of Formula Feeding and Breastfeeding on Child Growth, Infant Mortality, and HIV Transmission in Children Born to HIV-Infected Pregnant Women Who Received Triple Antiretroviral Therapy in a Resource-Limited Setting: Data from an HIV Cohort Study in India. ISRN Pediatr, 2012, Article ID: 763591.
[8] Arora, D., Gupta, R.M. and Kochar, S.P.S. (2014) Efficacy of Single Dose Nevirapine in Reducing Viral Load in HIV Positive Mother in Labour and Transmission of HIV Infection to New Born Babies as Part of Prevention of Parent to Child Transmission. Medical Journal Armed Forces India, 70, 309-314.
[9] Goswami, S. and Chakravorty, P.S. (2011) Prevention of Parent to Child Transmission of HIV (PPTCT): An Effort of 4 Years in a Tertiary Centre. The Journal of Obstetrics and Gynecology of India, 61, 394-398.
[10] Gupta, R., Praveen, R. and Sharma, M. (2013) Can We Prevent Pediatric HIV? An Experience at a Tertiary Care Hospital. Medical Journal Armed Forces India, 69, 218-221.
[11] Gupta, A., Gupte, N., Sastry, J., Bharucha, K.E., Bhosale, R., Kulkarni, P., et al. (2007) Mother-to-Child Transmission of HIV among Women Who Chose Not to Exclusively Breastfeed Their Infants in Pune, India. Indian Journal of Medical Research, 126, 131-134.
[12] Jain, K.K., Mahajan, R.K., Shevkani, M. and Kumar, P. (2011) Early Infant Diagnosis: A New Tool of HIV Diagnosis in Children. Indian Journal of Community Medicine, 36, 139-142.
[13] Joshi, U., Patel, S., Shah, K., Oza, U. and Modi, H. (2011) Studying PPTCT Services, Interventions, Coverage and Utilization in India. Journal of Global Infectious Diseases, 3, 371-377.
[14] Joshi, U., Kadri, A. and Bhojiya, S. (2010) Prevention of Parent to Child Transmission Services and Interventions- Coverage and Utilization: A Cohort Analysis in Gujarat, India. Indian Journal of Sexually Transmitted Diseases and AIDS, 31, 92-98. http://dx.doi.org/10.4103/0253-7184.74983
[15] Mandal, S., Bhattacharya, R.N., Chakraborty, M., Pal, P.P., Roy, S.G. and Mukherjee, G. (2010) Evaluation of the Prevention of Parent to Child Transmission Program in a Rural Tertiary Care Hospital of West Bengal, India. Indian Journal of Community Medicine, 35, 491-494.
[16] Merchant, R.H., Damania, K., Gilada, I.S., Bhagwat, R.V., Karkare, J.S., Oswal, J.S., et al. (2001) Strategy for Preventing Vertical Transmission of HIV: Bombay Experience. Indian Pediatrics, 38, 132-138.
[17] Omer, S.B., Six Week Extended Dose Nevirapine (SWEN) Study Team (2011) Twelve-Month Follow-Up of Six Week Extended Dose Nevirapine Randomized Controlled Trials: Differential Impact of Extended-Dose Nevirapine on Mother-to-Child Transmission and Infant Death by Maternal CD4 Cell Count. AIDS, 25, 767-776.
[18] Read, J.S., Samuel, N.M., Srijayanth, P., Dharmarajan, S., Van Hook, H.M., Jacob, M., et al. (2010) Infants of Human Immunodeficiency Virus Type 1-Infected Women in Rural South India: Feeding Patterns and Risk of Mother-to-Child Transmission. The Pediatric Infectious Disease Journal, 29, 14-17. http://dx.doi.org/10.1097/INF.0b013e3181b20ffc
[19] Seth, A., Gupta, R., Chandra, J., Maheshwari, A., Kumar, P. and Aneja, S. (2014) Adherence to Antiretroviral Therapy and Its Determinants in Children with HIV Infection—Experience from Paediatric Centre of Excellence in HIV Care in North India. AIDS Care, 26, 865-871.
[20] Shah, I. (2006) Is Elective Caesarian Section Really Essential for Prevention of Mother to Child Transmission of HIV in the Era of Antiretroviral Therapy and Abstinence of Breast Feeding? Journal of Tropical Pediatrics, 52, 163-165.
[21] Six Week Extended-Dose Nevirapine (SWEN) Study Team, Bedri, A., Gudetta, B., Isehak, A., Kumbi, S., Lulseged, S., et al. (2008) Extended-Dose Nevirapine to 6 Weeks of Age for Infants to Prevent HIV Transmission via Breastfeeding in Ethiopia, India, and Uganda: An Analysis of Three Randomized Controlled Trials. The Lancet, 372, 300-313.
[22] Chaudhuri, S., Mundle, M., Konar, H., Das, C., Talukdar, A. and Ghosh, U.S. (2010) Utilization of Therapeutic Intervention to Prevent Mother to Child Transmission of HIV in a Teaching Hospital in Kolkata, India. Journal of Obstetrics and Gynaecology Research, 36, 619-625.
[23] Ahir, S.P., Chavan, V., Kerkar, S., Samant-Mavani, P., Nanavati, R., Mehta, P.R., et al. (2013) Antiretroviral Treatment, Viral Load of Mothers & Perinatal HIV Transmission in Mumbai, India. Indian Journal of Medical Research, 138, 201-208.
[24] Gupta, A., Bhosale, R., Kinikar, A., Gupte, N., Bharadwaj, R., Kagal, A., et al. (2011) Maternal Tuberculosis: A Risk Factor for Mother-to-Child Transmission of Human Immunodeficiency Virus. Journal of Infectious Diseases, 203, 358-363. http://dx.doi.org/10.1093/jinfdis/jiq064
[25] Alvarez-Uria, G., Naik, P.K., Midde, M. and Pakam, R. (2013) Predictors of Delayed Entry into Medical Care of Children Diagnosed with HIV Infection: Data from an HIV Cohort Study in India. Scientific World Journal, 2013, Article ID: 737620.
[26] Alvarez-Uria, G., Naik, P.K., Midde, M. and Pakam, R. (2014) Predictors of Loss to Follow-Up after Engagement in Care of HIV-Infected Children Ineligible for Antiretroviral Therapy in an HIV Cohort Study in India. Germs, 4, 9-15.
[27] Banerjee, T., Pensi, T., Banerjee, D. and Grover, G. (2010) Impact of HAART on Survival, Weight Gain and Resting Energy Expenditure in HIV-1-Infected Children in India. Annals of Tropical Paediatrics, 30, 27-37.
[28] Bhattacharya, M. and Dubey, A.P. (2011) Adherence to Antiretroviral Therapy and Its Correlates among HIV-Infected Children at an HIV Clinic in New Delhi. Annals of Tropical Paediatrics, 31, 331-337.
[29] Bhattacharya, M. and Saxena, R. (2012) Outcome of Anti-Retroviral Treatment in HIV-Infected Orphans and Non-Orphans at an ART Centre in North India. Paediatrics and International Child Health, 32, 228-232.
[30] Choudhary, N., Gomber, S. and Narang, M. (2012) Clinico-Immunological Profile and Outcome of Antiretroviral Therapy in HIV-Positive Children. Public Health Nutrition, 15, 1442-1445.
[31] Gomber, S., Kaushik, J.S., Chandra, J. and Anand, R. (2011) Profile of HIV Infected Children from Delhi and Their Response to Antiretroviral Treatment. Indian Pediatrics, 48, 703-707.
[32] Seth, A., Chandra, J., Gupta, R., Kumar, P., Aggarwal, V. and Dutta, A. (2012) Outcome of HIV Exposed Infants: Experience of a Regional Pediatric Center for HIV in North India. Indian Journal of Pediatrics, 79, 188-193.
[33] Violari, A., Lindsey, J.C., Hughes, M.D., Mujuru, H.A., Barlow-Mosha, L., Kamthunzi, P., et al. (2012) Nevirapine versus Ritonavir-Boosted Lopinavir for HIV-Infected Children. The New England Journal of Medicine, 366, 2380-2389. http://dx.doi.org/10.1056/NEJMoa1113249
[34] De, A.K. and Dalui, A. (2012) Assessment of Factors Influencing Adherence to Anti-Retroviral Therapy for Human Immunodeficiency Virus Positive Mothers and Their Infected Children. Indian Journal of Medical Sciences, 66, 247- 259. http://dx.doi.org/10.4103/0019-5359.115733
[35] Rajasekaran, S., Jeyaseelan, L., Ravichandran, N., Gomathi, C., Thara, F. and Chandrasekar, C. (2009) Efficacy of Antiretroviral Therapy Program in Children in India: Prognostic Factors and Survival Analysis. Journal of Tropical Pediatrics, 55, 225-232. http://dx.doi.org/10.1093/tropej/fmm073
[36] Alvarez-Uria, G., Naik, P.K., Midde, M. and Pakam, R. (2014) Mortality and Loss to Follow up before Initiation of Antiretroviral Therapy among HIV-Infected Children Eligible for HIV Treatment. Infectious Disease Reports, 6, 5167.
[37] Gupta, A., Singh, G., Kaushik, P., Joshi, B., Kalra, K. and Chakraborty, S. (2013) Early Diagnosis of HIV in Children below 18 Months Using DNA PCR Test—Assessment of the Effectiveness of PMTCT Interventions and Challenges in Early Initiation of ART in a Resource-Limited Setting. Journal of Tropical Pediatrics, 59, 120-126.
[38] Radhakrishna, M., Durga, K., Rao, R.K., Reddy, D.M. and Kondapi, A.K. (2013) Factors Associated with Conversion of Long-Term Non-Progressors to Progressors: A Prospective Study of HIV Perinatally Infected Pediatric Survivors. Indian Journal of Medical Research, 138, 322-328.
[39] Department of AIDS Control, Ministry of Health and Family Welfare, Government of India (2013) National Strategic Plan; Multi Drug ARV for Prevention of Parent to Child Transmission of HIV (PPTCT) under National AIDS Control Programme in India.
[40] Department of AIDS Control, Ministry of Health and Family Welfare, Government of India (2014) Assessment of Parent to Child Transmission of HIV (PPTCT) Services Implementation in India.
[41] Department of AIDS Control, Ministry of Health and Family Welfare, Government of India (2013) Nutritional Guidelines for HIV Exposed and Infected Children (0-14 Years of Age).
[42] Badarau, D.O., Wangmo, T., Ruhe, K.M., Miron, I., Colita, A., Dragomir, M., Schildmann, J. and Elger, B.S. (2015) Parents’ Challenges and Physicians’ Tasks in Disclosing Cancer to Children. A Qualitative Interview Study and Reflections on Professional Duties in Pediatric Oncology. Pediatric Blood & Cancer. (In Press)

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