Clinical outcomes and survival of HIV exposed children at 18 months in post-conflict region: insight from the Panzi Interdisciplinary PMTCT cohort (Panzi IPC) study

Abstract Background Vertical transmission is the main mode of acquisition of HIV infection in the Democratic Republic of Congo (DRC). We aimed to determine the factors associated with the serological status of mothers and children born to HIV-positive mothers at 18 months, as well as the vital prognosis of infants within the prevention of mother-to-child transmission of HIV (PMTCT) service in the Department of Gynecology and Obstetrics at Panzi General Reference Hospital (GHRP) the vital prognosis of infants born to HIV-infected mothers at 18 months after birth. Methods A matched retrospective cohort of HIV-positive women who delivered and brought their children before and at 18 months of life in the PMTCT/Panzi program during the period from July 1, 2015, to July 1, 2020. Multivariate logistic regression and a Cox proportional hazards model were performed to assess factors associated with positive HIV serology (couple mother-baby) and the risk of HIV MTCT or death at 18 months of life, respectively. Results There were 6318 pregnant women identified, and four hundred were HIV positive. The study found that the prevalence of HIV-infected mothers was 6.3% (400/6318), and the prevalence of vertical HIV transmission was 6.9% (10/144). Premature rupture of the membranes was the most common maternal-foetal complication and was found in 11.1% of cases. Antiretroviral treatment was based on triple therapy (zidovudine (AZT) +lamivudine (3TC) + efavirenz (EFV) in the majority of cases (77.1%). Logistic regression analysis showed that the risk of HIV was higher in women with no education or primary education, no antenatal care, primiparity, and primigravida. Survival analysis showed that infant death at 18 months was characterized by maternal HIV positivity (HR=3.93; 95% CI: 1.39-11.10), prematurity (HR=4.66; 95% CI: 1.41-15.36), and the development of respiratory disease (HR=5.37; 95% CI: 1.65-17.47). Conclusion Compared WHO's elimination targets for MTCT rate of 2% or less, MTCT was high in our setting. This study’s findings highlight the need for intensified interventions to prevent MTCT and lead to healthier children, lessen the impact of HIV on individuals and healthcare systems, and are critical to achieving the goal of an HIV-free generation in DRC. Clinical trial Not applicable.