A Ukraine birth cohort of children with vertically acquired HIV infection

Background

HIV prevalence in Ukraine is estimated at 1.6%, with women comprising around half of the HIV-infected population, the vast majority of childbearing age. MTCT rates declined to 7–10% in 2007 following implementation of a national prevention of MTCT (PMTCT) programme in 2000, which to date has been based on single dose NVP (sdNVP) and/or short-course zidovudine. Little information is available on the natural and treated history of HIV infection in children living in Eastern Europe.

Methods

Within the European Collaborative Study, HIV-infected pregnant women and their infants were enrolled in 6 cities since 2000. Data on HIV-infected children followed from birth to December 2008 were analyzed from this ongoing study.

Results

There were a total of 162 infected children (47% female, 52% male), with average age at last follow-up of 19.1 months (IQR 9.1–44.0). A quarter had low birth weight, 19% (n = 31) were preterm and 25% delivered by Caesarean Section; 37% (n = 60) of mothers had an injecting drug use history. Most (n = 160) infants were bottlefed; four were breastfed briefly. Most (147, 91%) children were infected despite PMTCT prophylaxis (mostly single dose NVP, 62%). Ninety-two children had ≥ 1 CD4 counts; based on nadir CD4 count to date, half (n = 49) were classified in CDC immunological stage I, with 34% (n = 31) and 13% (n = 12) in CDC stage II and III, respectively. Forty-one percent (n = 66) of children had started highly active antiretroviral treatment (HAART) by most recent follow-up, at a median CD4 count of 1340 cells/mm³; of those with viral load measurements, 15.5% (n = 13/84) on treatment had achieved an undetectable viral load to date. Seventy-seven (48%) received PCP prophylaxis (mainly cotrimoxazole) and 8 children received TB prophylaxis. Overall, 3% of children were ever anaemic, with median haemoglobin of 11.5 gm/dl (range, 3.9–23.2 gm/dl). Twenty-two (14%) children had died by last follow-up, with a median age at death of 14.5 months (range, 1–47 months); nearly half (10, 45%) had developed AIDS before their death. Of the children who died, only one had been started on HAART (and had received cotrimoxazole). The most common causes of death were pneumonia (n = 5) and sepsis (n = 5). Overall, 7% (n = 11) children developed AIDS during follow-up. From survival analysis, estimated AIDS-free survival rates were 94%, 90% and 87% for children at age six, twelve and eighteen months, respectively. Survival analysis indicated a significantly improved survival rate among children born in 2004–2008 compared with those born earlier (P = 0.0002). The mothers of nine infected children were known to have died.

Conclusion

Less than half of our cohort of infected children had received HAART and/or PCP prophylaxis. However, the improvements in AIDS-free survival in more recent years reflect the scale-up of paediatric treatment in Ukraine.