Incidence of HIV-infected infants born to HIV- infected mothers with prophylactic therapy: Preliminary report of hospital birth cohort study

Nia Kurniati; T Nilamsari; Arwin AP Akib

doi:10.14238/pi46.5.2006.209-13

Nia Kurniati
T Nilamsari
Arwin AP Akib

DOI: https://doi.org/10.14238/pi46.5.2006.209-13

Keywords: HIV, HIV-pediatric, mother-to-child transmission

Abstract

Background Human immunodeficiency virus (HIV) is expanding
rapidly and was reported double in several places in Indonesia To
our knowledge, reports regarding HIV-infected infants are still
scarce.
Objectives To investigate the incidence of HIV-infected infants
born to HIV- mothers who had received prophylaxis therapy at birth.
Methods A prospective hospital-based cohort study was held from
January 2003 until December 2004 in Cipto Mangunkusumo Hos-
pital, Jakarta. The inclusion criteria were mothers with positive HIV
and their infants had been given anti retroviral (ARV) therapy. The
babies were followed up monthly and the status of infection was
determined by PCR at the age of 4 weeks and 6 months. Outcome
was measured based on PCR assays or clinical signs of HIV in-
fection.
Results The mothersâ€™ age ranged from 19 to 27 years. All of them
were carrying their first child and only 41% mothers took ARV pro-
phylaxis. Almost all mothers underwent caesarean section and the
infants had formula feeding. HIV infection was diagnosed in 7 in-
fants and 2 of them had RNA assays more than 5,000 copies/ml.
Six infants were negatives whereas 3 infants were diagnosed as
indeterminate HIV infection and needed further examination. One
needed no further investigation as the mother was seronegative.
Conclusions Preventing HIV transmission from mother to infant
can be done by giving ARV during prenatal, intrapartum, and post-
natal period to the newborn. In our hospital, transmission was con-
firmed in 6 of 17 infants. Unison protocol must be used and popu-
lation of HIV-pregnant mother must be registered in order to know
how high the transmission rate among Indonesian HIV people

Author Biographies

Nia Kurniati

Department of Child Health, Medical School, University of
Indonesia, Jakarta, Indonesia.

T Nilamsari

Department of Child Health, Medical School, University of
Indonesia, Jakarta, Indonesia.

Arwin AP Akib

Department of Child Health, Medical School, University of
Indonesia, Jakarta, Indonesia.

References

1. World Health Organization-regional office for South-
East Asia. HIV/AIDS facts and figures. Cited 2004
September 9. Available from http: url: //www.who/
searo/HIV-AIDS/factsandfigure.htm.
2. The Working Group on Antiretroviral and Medical
Management of HIV-Infected Children, The National
Resources and Services Administration, and The Na-
tional Institute of Health. Guidelines for the use of
antiretroviral agents in pediatric HIV infection. Cited
2004 November 30. Available from: url: http://
www.aidsinfo.org.
3. Dorenbaum A, Cunningham CK, Gelber RD, Culnane
M, Mofenson LM, Britto P, et al. Two-dose intrapar-
tum/newborn nevirapine and standard antiretroviral
therapy to reduce perinatal HIV transmission. JAMA
2002;288:189-98.
4. Ditjen PPM&PL Departemen Kesehatan Republik
Indonesia. Laporan triwulan pengidap infeksi HIV dan
kasus AIDS sampai dengan Desember 2004.
5. Akib AAP. Infeksi HIV pada bayi dan anak. Pertemuan
Ilmiah Tahunan Ikatan Dokter Anak Indonesia. Batam.
June 2004.
6. Mofenson LM. Overview of perinatal intervention tri-
als. Cited 2005 March. Available from: url: http://
www.womenchildrenhiv.org/
7. McSherry GD, Shapiro DE, Coombs RW. The effect
of zidovudine in the subset of infants infacted with
human immunodeficiendy virus type-1 (Pediatric AIDS
clinical trials group protocol 076). J Pediatr 1999;134:
717-24.
8. Chalermchokcharoenkit A, Asavapiriyanont S,
Teeraratkul A, Vanprapa N, Chotpitayasunondh T,
Chaowanachan T, et al. Combination short-course
zidovudine plus 2-dose nevirapine for prevention of
mother-to-child transmission: Safety, tolerance, trans-
mission, and resistance results. 11th Retrovirus and
Opportunistic Infection Conference. San Fransisco,
February 2004.
9. Djauzi S, Djoerban Z. Penatalaksanaan infeksi HIV di
pelayanan kesehatan dasar. Edisi ke-2. Jakarta: Balai
Penerbit FKUI; 2003. p. 67.
10. Ammann AJ. Pediatric human immunodeficiency vi-
rus infection. In: Stiehm ER, Ochs HD, Winkelstein
JA, editors. Immunologic disorders in infants and chil-
dren. 5th edition. Philadelphia: Elsevier Saunders;
2004. p. 878-951.