Background:  The DREAM program, managed by the Community of Sant’Egidio, attends a cohort of some 7000 HIV⁺ patients in Mozambique. Pregnant women follow a treatment protocol aimed at both to prevent vertical transmission of the virus and to treat the infection.

Methods:  Retrospective analysis of the clinical files of 778 pregnant women who received HAART for more than 14 days. HAART was administered to the women in 3 antenatal clinics. Nutritional supplements, formula milk after delivery, and a water filter device were also offered. The viral load and CD4 count of both mothers and newborns were monitored. The treatment package was completely free of charge. Women who did not have a CD4 count < 200/µL when starting HAART, stopped treatment 1 month after delivery. From January 1, 2004, HAART was stopped 6 months after delivery.

Results:  As on June 30, 2004, 515 deliveries were registered. HAART generic fixed-dose combinations were administered for an average of 73.9 days (SD ± 47.3). The mean pre-HAART viral load stood at 4.5 log copies/mL; close to 75% had a viral load lower than 3.0 log copies/mL at time of delivery (median undetectable –3.08, IQ 25 to 75). At the same time, the CD4 count increased from 528 to 679 cells/µL. The incidence of  grade 3-4hepatotoxicity or skin rashes was about 6 and 3%, respectively. Life-threatening cases were not observed.  The percentage of HIV⁺ babies at the ages of 1 and 6 months was 4.1 and 6.1 respectively. No infection has been recorded between 1 and 6 months in the year 2004. Factors associated to infection of newborns were:  pre-HAART viral load, duration of HAART before delivery, diagnosis of sexually transmitted disease and suspension of HAART before delivery, even if temporarily. We carried out the genotyping test on 20 samples after about 6 months of treatment suspension. The following results were obtained:  17 samples did not show mutations associated with drug-resistance, 2 patients, facing virologic failure before therapy was suspended, showed Nevirapine-associated mutations (K103N/K and G190A/G), 1 patient with a viral load undetectable before treatment was suspended, presented G190A/G mutation associated with Nevirapine.

Conclusions:  The DREAM cohort shows that a public health program with an holistic approach, focused on the administration of HAART during pregnancy, protects mothers’ health, as well as to lower HIV vertical transmission, without a high rate of drug resistance mutations.

Keywords: MTCT; HAART; Limited-Resource settings