What Works for Women and Girls

chose elective cesarean section to further reduce the risk of MTCT. Of 770 mother-infantpairs included, 87 percent of women had viral loads below 1000 copies/mL, 99 percentof women received one or more antiretrovirals during pregnancy, and 41 percent deliveredthrough elective cesarean section. Less than one percent of infants were diagnosedas HIV-positive at the end of the study period (Read et al., 2007). (Gray III) (treatment,cesarean section, PMTCT, Latin America, Caribbean)A study from the United States from 1997 to 2004 with 759 HIV-positive women (139pregnant women and 620 non-pregnant women) receiving HIV care found that incomparison to non-pregnant women, pregnant women had a lower risk of HIV diseaseprogression (defined as an AIDS defining event or death). All pregnant women weretreated with either HAART (86%) or non-HAART ART (14%). In comparison, 68%of non-pregnant women were treated with HAART, 9% with non-HAART ART and23% received no treatment. At the end of the study period 5% of pregnant vs. 7% ofnon-pregnant women experienced an AIDS-defining event only, 1% of pregnant vs.11% of non-pregnant women died and 2% of pregnant vs. 7% of non-pregnant womenexperienced both an AIDS-defining event and death. Overall 8% of pregnant womenvs. 24% of non-pregnant women experienced an AIDS-defining event or death. Otherpredictors of disease progression included a baseline CD4 count of greater than 200cells/mm 3 , a baseline HIV-1 RNA level of greater than 10,000 copies/mL, maternal age,HAART duration, non-HAART ART duration and durable virologic suppression. Theeffect of pregnancy on slower disease progression was still significant after controllingfor these previously listed clinical variables. Finally, women with more than one pregnancytended to have a lower risk of disease progression than women with only onepregnancy; however, this association was not statistically significant (Tai et al., 2007).(Gray III) (pregnancy, HAART, United States)A study from Côte d’Ivoire that enrolled HIV-positive pregnant women between 2003and 2005 in an MTCT-Plus program found that antiretroviral treatment for pregnantwomen, both indicated for the mother’s health as well as solely for PMTCT purposes,was effective and safe. Women with CD4 counts below 200 cells/mm 3 were consideredeligible for HAART for their own health and received a treatment combination ofmainly zidovudine (ZDV), lamivudine (3TC), and nevirapine (NVP). Women not eligiblefor HAART for their own health received a short course of ARVs, mainly ZDV and 3TCfrom 32 weeks of pregnancy until 3 days postpartum and a single dose of NVP duringlabor; ZDV from 28 weeks of pregnancy; single dose NVP; or ZDV and single dose NVP.All infants in the sample received ZDV syrup for 7 days after birth and a single dose ofNVP 3 days after birth regardless of mother’s ARV regimen. Of the 261 HIV-infectedwomen identified and enrolled in the study, 57% (143) received short-course ARVs and43% (107) received HAART. Overall, the HIV status of 97.4% (225) children was determinedwith 12 confirmed HIV infections. The probability of peripartum HIV infectionwas 2.2% for children born to mothers using HAART and 3.1% for children born tomothers using short-course ARVs. The only factor found to be significant in peripartumWHAT WORKS FOR WOMEN AND GIRLS239