EVALUATION OF THE DETERMINANTS OF MOTHER-TO-CHILD TRANSMISSION OF HUMAN IMMUNODEFICIENCY VIRUS IN INFANTS WHOSE MOTHERS HAD PMTCT INTERVENTIONS IN UNTH, ENUGU

Abstract

Mother-to-child-transmission (MTCT) is the predominant route of human immunodeficiency virus
(HIV) transmission in children. Prevention of mother-to-child transmission (PMTCT) of HIV is a
key component of overall HIV prevention efforts and represents a critical opportunity for stemming
the tide of the HIV epidemic. The burden of paediatric HIV is unacceptably high in Nigeria as the
country ranks second only to South Africa globally. Approximately 57,000 babies are born with HIV
each year in Nigeria.
This study aimed at determining the current rate of MTCT of HIV in infants whose mothers had
PMTCT interventions at the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu,
and to evaluate the risk factors associated with MTCT.
Over a 12 month period, a total of 204 HIV positive pregnant women in their third trimester,
attending antenatal clinic at UNTH, were consecutively recruited. Structured interviewer
administered questionnaire was used to ascertain the women’s socio-demographic profile and obtain
relevant information concerning their HIV disease. The levels of maternal HIV RNA levels (viral
load) and CD4 count were obtained. Labour and delivery events were also recorded. After delivery,
relevant information about the infants was documented and their Deoxyribonucleic Acid Polymerase
Chain Reaction (DNA PCR) for early infant diagnosis of HIV was done at six weeks of age for all
the infants. A repeat DNA PCR was done six to eight weeks after cessation of all forms of
breastfeeding for those that were breastfed.
There were a total of 210 infants made up of 198 singletons and 6 set of twins. Of the 210 babies in
this study, 2 had a positive DNA PCR result signifying positive HIV status. This gave an MTCT rate
of 1%. There was significant association between MTCT of HIV and maternal HIV RNA levels (p =
0 .009) and between MTCT of HIV and mixed feeding (p < 0.001). None of the other risk factor studied namely maternal CD4 count, mode of delivery and duration of rupture of fetal membrane
before delivery, had any influence on MTCT.
In conclusion, this study documented an MTCT rate of 1% and found maternal HIV RNA levels, and
feeding choice to be significant risk factors for MTCT of HIV. The rate of MTCT can be reduced
markedly if there is strict adherence to the PMTCT strategies. It is therefore, recommended that there
be increased access to PMTCT programme and full participation of mothers in Nigeria.

EVALUATION OF THE DETERMINANTS OF MOTHER-TO-CHILD TRANSMISSION OF HUMAN IMMUNODEFICIENCY VIRUS IN INFANTS WHOSE MOTHERS HAD PMTCT INTERVENTIONS IN UNTH, ENUGU