Maternal Highly Active Antiretroviral Therapy and Child HIV-Free Survival in Malawi, 2004–2009

Sheree R. Schwartz, Newton Kumwenda, Johnstone Kumwenda, Shu Chen, Lynne M. Mofenson, Allan W. Taylor, Mary Glenn Fowler, Taha E. Taha

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Objectives Highly active antiretroviral therapy (HAART) provision to eligible HIV-infected pregnant and post-partum women is critical for optimizing maternal health. We assessed the impact of maternal HAART on HIV-free survival of breastfed infants in Malawi. Methods The post-exposure prophylaxis of infants-Malawi trial (2004–2009) enrolled mothers/infants during labor or immediately post-partum to evaluate 14-week extended infant antiretroviral prophylaxis for preventing HIV transmission through breastfeeding. Mothers meeting national HAART guidelines were referred for therapy. Child HIV-free survival—survival without HIV infection—was compared by maternal HAART status. Results Overall, 3022 mother-infant pairs contributed 4214 infant/person-years (PY) at-risk for HIV infection or death, with 532 events (incidence 12.6/100 PY, 95 % confidence interval [CI] 11.6–13.7). During follow-up, 349 mothers were HAART initiated; 581 remained HAART naïve with CD4 cell counts <250 cells/mm3, and 2092 were never HAART-eligible. By 3 months, 11 % of infants with HAART naïve mothers (CD4 < 250) were infected with HIV or died versus 7 % of infants of HAART-initiated mothers and 4 % of infants of HAART-ineligible mothers. Maternal HAART was associated with a 46 % reduction in infant HIV infection or death as compared to infants with HAART naïve mothers (CD4 < 250) (adjusted hazards ratio 0.54, 95 % CI 0.36–0.81). Among HIV-exposed, uninfected infants, breastfeeding, but not HAART, was significantly associated with decreased child mortality. Conclusions HIV infection and mortality are high during the first 3 months post-partum in infants of mothers with advanced HIV, and rapid maternal HAART initiation can significantly improve HIV-related infant outcomes. Clinical Trials Registration This study is registered at under trial number NCT00115648.

Original languageEnglish (US)
Pages (from-to)542-549
Number of pages8
JournalMaternal and child health journal
Issue number3
StatePublished - Mar 1 2016


  • Breastfeeding
  • Child survival
  • HIV-1
  • Highly active antiretroviral therapy
  • Prevention of mother-to-child transmission

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Obstetrics and Gynecology
  • Epidemiology
  • Pediatrics, Perinatology, and Child Health


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