Outcomes of Long-Term Antiretroviral Therapy in Mothers, HIV-Exposed Children

Researchers assessed the effects of long-term antiretroviral therapy among women of reproductive age with HIV infection and HIV-exposed children.

Long-term antiretroviral therapy (ART) was safe and associated with increased rates of survival among both women of reproductive age and HIV-exposed children, according to findings published in Lancet HIV.

Researchers performed a prospective, observational, longitudinal, multicenter study to assess the long-term effects of ART among mothers aged between 15 and 49 years with HIV infection. Data on ART use among both mothers and children exposed to HIV-infection were collected at follow-up visits every 6 months. The primary outcomes were ART retention and adherence, maternal health, fertility intentions, and safety.

A total of 1987 mothers and 2522 children were included in the analysis. Between baseline and at 42 months, the number of women with an undetectable HIV viral load increased from 84.8% to 89.1%. In addition, the number of women who self-reported their health as “very good” or “excellent” increased from 67.5% at baseline to 87.5% at 42 months. At 36 months, the rate of self-reported ART adherence ranged between 73.4% and 97.6%.

Among women who became pregnant during the study period (n=1006), adverse pregnancy outcomes including low birth weight (2.5%), preterm birth (2.5%), and stillbirths (2.3%) were uncommon. The incidence rate of mortality per 1000 person-years was 2.4 (95% CI, 1.4-3.9) and 3.4 (95% CI, 2.2-5.10) among mothers and children, respectively. Of 22 children who died, only 1 had previously received a diagnosis of HIV infection. Of 15 mothers who died, 4 died of efavirenz-induced liver toxicity.

This study was limited as adherence to ART was determined on the basis of only HIV viral load suppression without consideration of potential ART resistance.

According to the researchers, “ART is safe and effective and improves overall long-term health and survival of women living with HIV [infection] and their children…”

Disclosure: One author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Taha TE, Yende-Zuma N, Brummel SS, et al. Effects of long-term antiretroviral therapy in reproductive-age women in sub-Saharan Africa (the PEPFAR PROMOTE study): a multi-country observational cohort study. Lancet HIV. Published online April 27, 2022. doi:10.1016/S2352-3018(22)00037-6