Objective: Since 2010, Nigeria has adopted World Health Organization (WHO) ‘Option B’
which requires administration of triple antiretroviral prophylaxis or treatment (ART) to all HIVinfected
pregnant women. We studied the transmission outcomes of HIV-exposed children up to 18
months of age.
Design: This was a retrospective, observational study of HIV-infected pregnant women and their
exposed infants who accessed prevention of mother to child transmission (PMTCT) services at Jos University Teaching
Hospital, Jos, North-central Nigeria.
Methods: HIV-infected women were enrolled during antenatal care or at labor/delivery between January 1, 2010 and
December 31, 2012. Antiretroviral (ARV) prophylaxis/therapy was provided according to the 2010 Nigerian PMTCT
guidelines (adapted WHO 2010 guidelines); Infant HIV diagnosis was performed at 6 weeks and at 6 months. HIV
antibody diagnosis was used for exposed children at 18 months.
Results: A total of 996 HIV-exposed children were followed up. Of those children, 140 (14.1%) were lost to follow up by
18 months of age. Twelve children (1.4%) died (all HIV negative) before 18 months of age and six infants (0.7%) were
confirmed to be HIV-infected (4 by the age of 6 months and 2 thereafter) and were referred for treatment. A total of 838
(84.1%) children tested HIV negative at 18 months and were discharged.
Mother-to-child transmission (MTCT) of HIV by 18 months was lower among women on ART before pregnancy
compared to those women who started ART/Triple ARV prophylaxis during pregnancy/delivery. (0.4%; 3/700 vs 2.0%;
Home delivery was associated with higher transmission than facility delivery (p=0.03). Mode of delivery or method of
infant feeding had no significant impact on vertical transmission by 18 months.
Conclusion: In North-central Nigeria where HIV is prevalent, ART started before pregnancy is enormously effective in
preventing mother-to-child transmission. Adoption of WHO ‘Option B+’ deserves serious consideration in such settings.