Taking maternal viral load into account HIV

Taking maternal viral load into account HIV-infection risk was over 40% lower in infants born to women accompanied by their male partners compared to those unaccompanied (adjusted hazard ratio (aHR)=0.56; 95% CI: 0.33-0.98; P=0.042).

The same held true with reported prior partner HIV testing compared to no report of previous partner testing (adjusted hazard ratio (aHR)=0.52; 95% CI: 0.32-0.84; P=0.008).

Adjusting for maternal viral load and breastfeeding, the combined risk for vertical transmission or infant death was significantly lower with antenatal partner attendance than without (aHR=0.55; 95%CI: 0.35-0.88; P=0.012) as well as with reporting of previous partner testing than without (aHR=0.58; 95% CI: 0.34-0.88; P=0.01).

The authors note this study shows that male partner involvement provides a significantly lower risk for HIV infection as well as improved HIV-free survival in infants born to HIV-infected women when compared to infants born to women without male involvement.

While these findings are consistent with other studies, this study differs in that HIV-infection and infant mortality are looked at rather than numbers accessing an intervention, for example. This finding, the authors note, provides critical new evidence for male involvement as a potential, currently underused, public health intervention.

The authors note that while PMTCT programmes in sub-Saharan Africa promote partner HIV testing they do not specifically encourage antenatal attendance for partners of HIV-infected women.

These findings support the need to further define specific male partner factors that are associated with improved health outcomes in maternal and child health programmes, they note. Barriers to partner testing and participation in antenatal settings also need to be addressed, the authors add.

71 (16%) infants died, of whom 28 (39%) were HIV-infected, 31 (44%) HIV- uninfected, and the remaining 12 (17%) of unknown status.

The mortality risk among HIV-uninfected infants born to women with antenatal partner attendance was 63% less than in those whose mothers were unaccompanied. The authors note that with increasing rates of antenatal HIV testing and improved antiretroviral treatment HIV-exposed but uninfected children make up the majority of infants born to HIV-infected mothers. So bringing down the death rates among this group will provide considerable public health benefits.

However, the authors also noted a disturbing trend that needs further exploration: increased mortality risk among HIV-infected infants born to women with partner attendance.

Limitations include not taking into account the possible negative effects of male involvement, in particular domestic violence. The authors suggest these be monitored in future studies.

A second limitation involves bias when answering sensitive questions concerning HIV testing and disclosure of their partner’s status.

The authors conclude that “these data suggest that incorporating men into PMTCT programmes with associated HIV testing may improve infant health outcomes by reducing both vertical transmission and mortality among uninfected infants.”