Role of Triple Drug Antiretroviral Prophylaxis in Reducing Mother-to-Child Transmission of Human Immunodeficiency Virus

Abstract

Aim: To study the efficacy of the triple drug (Antiretroviral [ARV] prophylaxis i.e., Tenofovir, Lamivudine and Efavirenz as a single tablet) in reducing the parent to child transmission of human immunodeficiency virus [HIV] virus in the antenatal period, labor and postpartum period. Materials and Methods: This study was done at Government Maternity Hospital, Hanamkonda in the Department of obstertics and gynecology, Kakatiya Medical College between November 15, 2012 and October 15, 2014. This was a prospective case study. Number of patients eligible for ARV prophylaxis was 60 and percentage of seroprevalence was 0.75%. Results: 85% of the subjects are attending the antenatal clinic before 25 weeks of gestation. In our study, 83.32% of the subjects started receiving ARV/antiretroviral therapy (ART) prophylaxis between 14 and 25 weeks gestation. 96.66% (58) of the subjects took the drug regularly and were compliant to the drug and only 3.33% (2) have not taken the drug due to side effects, such as vomiting, giddiness, and nausea. 66.6% subjects were delivered by vaginal delivery and cesarean section rate was over all 33.3% which were done for obstetric indication. The delivery and the cesarean section were done as per universal precautions. 84.8% of the neonates were born with weight ranging from 2.5 to 3.9 kg and 13.2% of the neonates were born with weight ranging from 1.5 to 2.4 kg and only 1.6% with <1.5 kg. Out of total subjects of 60, the total number of adverse fetal outcome were 8 (13.3%). Of which, IUD constituted 3 (5%), Still birth constituted 3 (5%) and early neonatal deaths constituted 2 (3.3%). As recommended by e National acquired immunodeficiency syndrome Control Organisation this study has initiated exclusive breast feeding in 95% (57 of 60) of the neonates. The 5% (3 of 60) of the neonates have received artificial feeding on request. 28.3% are followed up to 18 months,31.6%, up to 12 months, 26.6%, up to 6 months and 13.3% infants have not followed due to IUD, Still born and early neonatal deaths. Conclusion: Triple drug ARV prophylaxis/ART is more efficacious when compared to single drug Nevirapine/Zidovudine in all aspects and is having few side effects and drug compliance is also better. The triple drug ARV prophylaxis/ART allows the spontaneous vaginal delivery because of the significant reduction in viral loads <50 HIV RNA copies per mL.