Search

Background About 26 million people are living with HIV in sub-Saharan Africa. The DREAM programme in sub-Saharan Africa provides free healthcare for HIV/AIDS and a range of chronic non-communicable diseases. HIV is a risk factor for neurological non-communicable diseases including stroke and epilepsy, which themselves are associated with headache, and HIV may be a direct risk factor for headache. We investigated the prevalence and burden of headache in a HIV+ population in sub-Saharan Africa. Methods At the DREAM Centre in Blantyre, Malawi, a low-income country with a population of 19 million and 9.2% HIV prevalence, a structured questionnaire was administered by a trained lay interviewer to consecutively attending HIV+ patients aged 6–65 years. All were monitored with regular viral load detection. Results Of 513 eligible patients invited, 498 were included (mean age 34.1 ± 12.8 years; 72% females; 15 declined). All were on antiretroviral treatment, with viral load undetectable in 83.9%. The 1-year prevalence of headache was 80.3% (females 83.6%, males 71.9%); 3.8% had ≥15 headache days/month, 1.4% had probable medication-overuse headache. Mean overall headache frequency was 4.4 ± 5.4 days/month. Those reporting headache lost means of 2.3% of paid workdays and 3.3% of household workdays because of headache. Only one third had sought advice for their headache. Conclusions Headache is very prevalent among HIV+ patients in Malawi, imposing additional burden and costs on individuals and the community. Management of headache disorders should be implemented in HIV centres, as it is for other chronic non-communicable diseases.

Introduction:some studies reported that 25.5% of African population presents hypercholesterolemia; however, epidemiology of hypercholesterolemia in Africa is poorly described. Mozambique is experiencing a constant growth of non-communicable diseases, but scarce data are available about hypercholesterolemia. Our study aims at describing the prevalence of hypercholesterolemia in patients with diabetes and hypertension in Mozambique and investigate possible risk factors. Methods:we conducted a cross-sectional study involving all the patients diagnosed with hypertension and/or diabetes from June 2018 to November 2020 in the Zimpeto DREAM Centre (Maputo, Mozambique). For each patient, anthropometric, clinical and laboratory data were collected. Hypercholesterolemia was defined as total blood cholesterol >200 mg/dL. Univariable and multivariable analysis were perfumed. Results:a total of 885 patients were included, 76.2% (n=674) female. Hypertension alone was diagnosed in 670 (75.7%) patients, diabetes in 109 (12.3%) patients and 106 (11.9%) both diseases. Hypercholesterolemia was present in 410 (46.3%) patients and it was more prevalent in patients diagnosed with both diabetes and hypertension (52.8%), as compared to the patients diagnosed with hypertension (46.9%) or diabetes alone (36.7%). In the multivariable analysis, the only factors independently associated with hypercholesterolemia were female sex (aOR 1.77, 95% CI 1.26-2.48, p=0.001) and a body mass index >25kg/m2(aOR 1.50, 95% CI 1.11-2.04, p=0.008). Conclusion:our results highlight the need for a specific focus on female and obese/overweight patients, especially if diagnosed with both hypertension and diabetes, to promptly detect metabolic disorders and establish temporary preventive measures for cardiovascular events.

Objective: Tuberculosis (TB) is the leading cause of death in HIV-positive people. In Kenya, 140 000 new TB cases occurred in 2019, and 13 000 HIV-positive patients died due to TB. The objective of this study was to investigate the role of high-sensitivity C-reactive protein (HS-CRP) in TB diagnosis and the prediction of mortality in HIV-positive patients. Methods: The IDEA-TB Study enrolled HIV-positive adult patients attending three DREAM centres in Kenya who were suspected of having TB. A lateral flow urine lipoarabinomannan assay (LF-LAM), serum HS-CRP, and GeneXpert MTB/RIF assay (Xpert MTB/RIF) were performed. Six-month survival was evaluated. Results: A total of 574 patients were enrolled. The median (interquartile range) age, body mass index, and CD4 count were 45 years (37–54 years), 20.5 kg/m2 (18.5–23.69 kg/m2), and 477 cells/mL (290–700 cells/mL), respectively. TB was confirmed in 87 (15.2%) patients. Concordance between the Xpert MTB/RIF and LF-LAM tests was 87.1%. HS-CRP was higher in TB patients (35.39 mg/l vs 9.21 mg/l). Malnutrition and elevated HS-CRP were associated with TB: odds ratio (OR) 2.5 (95% confidence interval (CI) 1.14–5.72) and OR 6.6 (95% CI 3.87–11.52), respectively. Nine (1.6%) patients died during follow-up. No single factor was associated with mortality. Only the combination of malnutrition and elevated HS-CRP was highly predictive of death (odds ratio (OR) 9.8, 95% CI 1.88–50.95); the association was stronger in TB patients (33.3% vs 1.0%; OR 47.6, 95% CI 7.03–322.23). Conclusion: TB diagnosis in HIV-positive patients remains challenging. HS-CRP could play a role in predicting early mortality in symptomatic patients.

Background: Few studies have evaluated the mortality rate in individuals with HIV initiating antiretroviral therapy (ART), undergoing screening with combined or repeated rapid tests for tuberculosis (TB). Methods: All individuals with HIV starting ART, irrespective of the presence of TB-related symptoms, received two consecutive Xpert tests plus a rapid test for the detection of mycobacterial lipoarabinomannan in urine (LAM). Mortality was evaluated by Kaplan–Meier analysis using the log-rank test in univariate analyses and Cox regression models with time-dependent covariates in multivariate analyses. Results: Among 972 individuals screened with combined tests, 98 (10.1%) tested positive for TB with Xpert, LAM, or both. At the end of the study, 780 (80.2%) had completed 2 years of follow-up, 39 (4.0%) had died, and 153 (15.7%) were lost to follow-up. In the multivariate analyses, the factors significantly associated with mortality were missed ART (hazard ratio (HR) 7.05, 95% confidence interval (CI) 2.33–21.35), symptomatic HIV disease (WHO-HIV stage >1) (HR 3.31, 95% CI 1.28–8.54), and low CD4 count (

Eighty percent of people with stroke live in low- to middle-income nations, particularly in sub-Saharan Africa (SSA) where stroke has increased by more than 100% in the last decades. More than one-third of all epilepsy−related deaths occur in SSA. HIV infection is a risk factor for neurological disorders, including stroke and epilepsy. The vast majority of the 38 million people living with HIV/AIDS are in SSA, and the burden of neurological disorders in SSA parallels that of HIV/AIDS. Local healthcare systems are weak. Many standalone HIV health centres have become a platform with combined treatment for both HIV and noncommunicable diseases (NCDs), as advised by the United Nations. The COVID-19 pandemic is overwhelming the fragile health systems in SSA, and it is feared it will provoke an upsurge of excess deaths due to the disruption of care for chronic diseases such as HIV, TB, hypertension, diabetes, and cerebrovascular disorders. Disease Relief through Excellent and Advanced Means (DREAM) is a health programme active since 2002 to prevent and treat HIV/AIDS and related disorders in 10 SSA countries. DREAM is scaling up management of NCDs, including neurologic disorders such as stroke and epilepsy. We described challenges and solutions to address disruption and excess deaths from these diseases during the ongoing COVID-19 pandemic.

The vision behind the DREAM programme is that of an Euro-African response to the enormous challenge of healthcare in Africa, together with a large bet on local staff. In fact there is a great commitment from European professionals in terms of support, training and, in this case, monitoring.

European Union has been active in recent years in promoting the enhancement of railway transports through research and development programs. The related challenges are even more critical for freight trains, because there is neither power supply guaranteed for every wagon nor data connection from and towards the locomotive. In this context the present paper proposes a plug-and-play solution for continuous monitoring of both wagon units and trains in order to improve freight trains safety and enable a more efficient overall management. This paper reports on the design and development of an integrated and heterogeneous network that involves on board communication/data exchange through an 868 MHz WSN (Wireless Sensor Network) component, data communications across a mobile network through M2M (Machine-to-Machine) SIMs, data collection on the Cloud for processing and detection of anomalies. A lab prototype has been built and tested, and is ready for large scale testing in real scenarios.

Since February 2002, the Drug Resources Enhancement against AIDS and Malnutrition Program has provided highly active antiretroviral therapy (HAART) and immunologic and virologic monitoring free of charge. We conducted a cohort study of persons infected with human immunodeficiency virus in Mozambique. Only persons treated with HAART with available CD4 cell counts at baseline and ≥ 1 CD4 cell count after HAART were included. Survival analysis was applied to evaluate the prognostic value of CD4 cell counts measured at three months. Possible confounders were considered. A total of 753 persons who started HAART included; 59% were females. Median age was 34 years (range = 16–67 years), and the median CD4 cell count at baseline was 172 cells/mm3 (interquartile range = 87–261 cells/mm3, range = 0–1,322 cells/mm3). Overall, 105 persons (14%) died. Of these persons 54 (51%) developed AIDS before they died; 25 (3%) died during the first three months. After three months of therapy, the individual median CD4 cell count change from the baseline value was +101 cells/mm3 (interquartile range = +27 to +187 cells/mm3, range = –723 to +310 cells/mm3). A median CD4 increment of 100 cells/mm3 in three months was associated with a mortality reduction of 50% compared with an increase of < 50 cells (relative hazard of death adjusted for baseline CD4 cell count = 0.54, 95% confidence interval = 0.30–0.95). A good initial response to HAART was associated with a significant reduction of mortality. This finding supports the effectiveness of HAART in resource-poor settings.

A concatenation of Reed-Solomon and repetition codes with symbol interleaving is considered for applications in which the message length is limited and the probability of incorrect received symbols is high. An analysis is developed with reference to a Packet Radio Network, using Spread Spectrum modulation, simultaneously affected by random errors and burst emors. The results obtained are compared with those derived by numerical simulation. It is shown that a canonical formulation can be used for the case of full interleavers, but it cannot be applied to encoding schemes with partial interleavers. In the latter situation a modified, improved, approach is proposed.

We analyzed the sequences of the HIV viral populations obtained from plasma, cell-free breast milk, and breast milk cells of HAART-treated (23) and untreated (30) HIV-infected women to obtain information about the origin of the breast milk virus. Sequence analyses of viruses were performed using the TruGene HIV-1 assay. Direct sequences of the reverse transcriptase (RT) and protease (PR) genes were analyzed using the Phylip 3.68 suite of sequence analysis program and pairwise evolutionary distances were calculated with the Kimura two parameter model for estimation of distances. We found that the genetic distances between the plasma and the cell-free breast milk viruses and between the cell-free and cell-associated breast milk viruses for RT were higher in HAART-receiving women than in untreated women, suggesting viral evolution under selective drug pressure in breast milk. Our data support the hypothesis of the presence of an actively replicating viral population in the breast milk compartment, distinct from that present in plasma.

The Drug Resource Enhancement against AIDS and Malnutrition Program (DREAM) gathered professionals in the field of Elimination of HIV-Mother-To-Child Transmission (EMTCT) in Maputo in 2013 to discuss obstacles and solutions for the elimination of HIV vertical transmission in sub-Saharan Africa. During this workshop, the benefits of administrating combined antiretroviral therapy (cART) to HIV positive women from pregnancy throughout breastfeeding were reviewed. cART is capable of reducing vertical transmission to less than 5% at 24 months of age, as well as maternal mortality and infant mortality in both HIV infected and exposed populations to levels similar to those of uninfected individuals. The challenge for programs targeting eMTCT in developing countries is retention in care and treatment adherence. Both are intrinsically related to the model of care. The drop-out from eMTCT programs before cART initiation ranges from 33%–88% while retention rates at 18–24 months are less than 50%. Comprehensive strategies including peer-to-peer education, social support and laboratory monitoring can reduce refusals to less than 5% and attain retention rates approaching 90%. Several components of the model of care for reduction of HIV-1 MTCT are feasible and implementable in scale-up strategies. A review of this model of care for HIV eMTCT is provided.

We conducted a retrospective cohort study of HIV-infected pregnant women and their infants enrolled in the DREAM programme for prevention of HIV mother-to-child transmission (MTCT) in Mozambique. All women delivering between May 2002 and December 2005 were offered participation. The programme consisted of the provision of highly active anti-retroviral therapy (HAART) to pregnant women until 6 months postpartum, and formula, clean water, nutritional supplementation, and continuing HAART to mothers if necessary. In Mozambique 1,259 HIV-positive pregnant women were offered participation: 212 (14.4%; CL95% 12.6–16.2) refused, 54 (3.7%; CL95% 2.5–4.9) dropped out during pregnancy, and eight women died. The remaining 985 women participated, giving birth to 958 infants, including 21 sets of twins. An additional 28 babies were stillborn. Spontaneous abortions occurred in 20 cases. Discontinuation of anti-retroviral (ARV) therapy by mothers was 3.7% (54/1,464) before delivery, 1.5% in the first month (23/ 1,464), and 1.5% (22/1,464) between the first and sixth months after delivery. Overall drop-out rates were 5.2% (CL95% 4.6–5.8). Approximately 80% of pregnant women completed the treatment protocol. Eur J Pediatr (2007) 166:1305–1307 DOI 10.1007/s00431-006-0405-8

identified among the 141 HIV-infected women, of which 16 viral types were classified as cancer high-risk or probable high-risk viruses. The most common types identified were HPV types 58 (12.1%, p < 0.001), 16 (10.7%, p = 0.06), 61 (8.4%, p < 0.05), 53 (7.9%, p = 0.55) and 6 (7.6%, p = 0.41). Nineteen distinct HPV genotypes were identified among the 50 HIV-uninfected women. Ten types were of high-risk or probable high-risk. The most common types identified in HIV-uninfected subjects were HPV types 53 (10.4%), 6 (9.1%), 16 (9.1%), 18 (9.1%) and 66 (7.8%). Discussion HPV infection was mainly associated with HIV positive status. HPV multiple infections were high in the population studied, independently of HIV status. HPV Genotypes are different in the two groups. The HPV types identified are partially different from those more commonly identified in Western countries.

Background. Antiretroviral treatment programs in sub-Saharan Africa have high rates of early mortality and loss to follow-up. Switching to second-line regimens is often delayed because of limited access to laboratory monitoring. Methods. Retrospective analysis was performed of a cohort of adults who initiated a standard first-line antiretroviral treatment at 5 public sector sites in 3 African countries. Monitoring included routine CD4 cell counts, human immunodeficiency virus RNA measures, and records of whether appointments were kept. Incidence and predictors of death, loss to follow-up, and switch to second-line regimens were analyzed by time-to-event approaches. Results. A total of 3749 patients were analyzed; at baseline, 37.1% were classified as having World Health Organization disease stage 3 or 4, and the median CD4 cell count was 192 cells/mu L. First-line regimens were nevirapine based in 96.5% of patients; 17.7% of patients attended

The use of simplified methods for viral load determination could greatly increase access to treatment monitoring of HIV patients in resource-limited countries.The aim of the present study was to optimize and evaluate the performance of the Roche COBAS Taqman assay in HIV-RNA quantification from dried blood spots (DBS) and dried plasma spots (DPS).EDTA blood samples from 108 HIV-infected women were used to prepare 129 DBS and 76 DPS on Whatman 903 card. DBS and DPS were stored at -20 degrees C. HIV-1 RNA was extracted from DBS/DPS using the MiniMAG system (bioMerieux). Amplification and detection were performed using the Roche COBAS TaqMan assay. Plasma viral load results were used as standard.There was a high correlation between measures of viral load in plasma and in DBS/DPS (r=0.96 and 0.85 respectively, P0.001). Overall, viral load values in DBS and DPS tended to be lower than in plasma with mean (SD) differences of 0.32 log(0.22) for DBS and of 0.35 (0.33) for DPS. Detection rates were 96.4% for DBS and 96.1% for DPS in samples with corresponding plasma values3.0 log copies/ml. Samples with HIV-RNA below 50 copies/ml were correctly identified in 18/19 DBS and in 7/7 DPS.Both DBS and DPS provided results highly correlated to the plasma values. High detection rate was obtained with both DBS and DPS when HIV-RNA was3.0 log copies/ml. Our results support the use of DBS/DPS to detect virologic failure in resource-limited settings.

The response to treatment and risk factors for early mortality following initiation of combination antiretrovirals(ARVs) in a cohort of African patients are described in a retrospective cohort design. Medical history, laboratory parameters, and mortality data were reviewed for patients initiating ARVs in 12 clinical centers in Mozambique, Tanzania, and Malawi. Among 3456 HIV-1-infected patients who received ARVs for more than 6 months, at baseline 72% had WHO clinical stages 3/4, 7% had a viral load 400 copies/ml, and 38% had a CD4 cell count200/microl. One year later, 78% had undetectable virus loads and 79% had CD4 cell counts200 cells/mm3. In the first year of HAART 260 deaths occurred (97 per 1000 person/years) with mortality peaking in the first 3 months. The highest mortality was observed in patients with low BMI, low hemoglobin levels, and CD4 values200 cells/microl at baseline. Mortality rates following initiation of HAART are higher in patients in resource-limited areas, particularly in the first 90 days following treatment initiation.HAART initiated at higher CD4 cell count levels, especially among malnourished and/or anemic patients, will carry significant public health impact.

Maintaining treatment adherence among the growing number of patients receiving antiretroviral treatment in Africa is a dramatic challenge. The objective of our study was to explore the results of a computerized pill count method and to test the validity, sensitivity, and specificity of this method with respect to viral load measurement in an African setting.We performed a prospective, observational study involving patients who received first-line highly active antiretroviral therapy in Mozambique from 1 April 2005 through 31 March 2006. Enrolled patients had received treatment for at least 3 months before the study. For defining treatment adherence levels, pill counts were used, and the results were analyzed with viral load measurements at the end of the observation period.The study involved 531 participants. During the 12 months of observation, 137 patients left the program or discontinued first-line therapy. Of the remaining 394 patients, 284 (72.1%) had95% treatment adherence; of those 284 patients, 274 (96.5%) had a final viral load1000 copies/mL. A Cox proportional hazards analysis revealed that the relationship between95% treatment adherence and the final viral load was closer than that between90% treatment adherence and viral load.Treatment adherence95% maximizes the results of the nonnucleoside reverse-transcriptase inhibitor-based regimen. The pill count method appears to be a reliable and economic tool for monitoring treatment adherence in resource-limited settings.

The paper addresses the integration architecture (I-concept) between a terrestrial technology--TETRA (TErrestrial Trunked Radio)--and satellite systems. This approach, that enhances and harmonises the features of both technologies, could provide an interesting contribution to the effectiveness of the International Mobile Telecommunications-Advanced (IMT-A) and, hence, to the 4G vision. TETRA can represent an interesting building block of an integrated network devoted to both civil and military scenarios; it meets the "suitable technological capability" requirement for integration, because it represents a consolidated terrestrial technology that can be trusted, hence focusing the integration effort on the definition, design and implementation of proper interfaces. System architectures are here proposed referring to short, medium term and long term scenarios.

Mother-to-child transmission via breastfeeding accounts for a relevant proportion of pediatric HIV infections in resource-limited countries. Highly-active antiretroviral therapy (HAART) prophylaxis administered to breastfeeding mothers has been proposed as a possible strategy to prevent postnatal transmission and indeed the recently reported results of two studies assessing this approach are encouraging. One of the possible obstacles to the use of this preventive strategy is that the different penetration of antiretroviral drugs into the breast milk could favour the emergence of resistance and be associated to the transmission of resistant strains. In this study we analyzed the resistance mutation patterns of plasma and breast milk viral populations in women receiving HAART for mother-to-child transmission prevention in order to assess the frequency of mutations in these women and to evaluate if different patterns arise between plasma and breast milk. (excerpt)

Objective To assess the incidence and consequences of adverse reactions among African HIV-positive pregnant women treated with fixed-dose combinations of a nevirapine-containing antiretroviral (ARV) triple therapy. Methods A retrospective analysis of the clinical files of 703 HIV-1-positive pregnant women treated with a nevirapine-containing regimen between May 2002 and July 2004 was conducted. Selection criteria for inclusion in the analysis were: (a) taking ARV for more than 14 days; (b) baseline values of transaminases below the threshold of 2.5 times the upper limit of normal (ULN). The women were on a nevirapine-containing regimen for a median of 127 days [interquartile range (IQR) 86–190 days], starting on average at the 27th week of gestation (standard deviation±9.5) and continuing up to a maximum of 6 months after delivery. All women were offered formula milk to feed the babies. Highly active antiretroviral therapy (HAART) was continued beyond 6 months only if the patient qualified on the first visit. The main outcome measures were incidence of hepatotoxicity, skin rashes and Stevens–Johnson syndrome. Multivariate analysis to assess the impact of several factors on the adverse reaction rate was performed. Results As of 1 August 2004, 554 pregnancies reached term, 96 women were still pregnant, and 53 women dropped out of the programme before giving birth. After 2 months of therapy the percentage of patients with a viral load less than 1000 HIV-1 RNA copies/mL increased to 78.6%; average CD4 cell counts increased from 490 cells/μL before therapy to 630 after therapy. The incidence of grade 3–4 adverse reactions (hepatotoxicity, skin rashes and Stevens–Johnson syndrome) was 6.5, 2.4 and 1.1%, respectively. Five women died during pregnancy (0.88%). Only one of the deaths could be associated with ARV treatment. Conclusion Nevirapine-containing regimens in pregnant woman, at all CD4 cell count levels, appear to be safe in African settings.

Ensuring high levels of adherence to highly active anti-retroviral therapy (HAART) is a priority in treating people living with AIDS. This study reports the rates of adherence of patients served by DREAM (Drug Resource Enhancement against AIDS and Malnutrition) in the city of Matola, Mozambique. DREAM, an innovative programme tailored for Africa, was implemented by the Community of Sant'Egidio in August 2001. DREAM provides patients with anti-retroviral drugs and laboratory tests at no charge, and is based on a particular strategy of health education and organization of services designed for a population that is predominantly poor and has a low level of formal education. This study analyzes the adherence of 154 patients over a period of 6 months. In evaluating adherence, two indicators were used: (1) the percentage of appointments kept for check-ups, tests and the collection of medicine, and (2) the overall change in the patients' blood chemistry over the 6-month period. Of the 154 patients, 127 (82.5%) kept more than 90% of their appointments. Adherence to the programme was further confirmed by a relevant increase of hemoglobin levels and CD4 counts, and a significant decrease in the viral loads among the 154 patients.

This study is aimed at assessing the outcomes of home care treatment for people living with AIDS in Mozambique. The authors have analysed data from 62 adult patients undergoing a Home Care Program carried out by the Sant'Egidio Community, Italy and the Sue Ryder Care in Matola, Mozambique. The above-mentioned program complies with the WHO guidelines and provides for free antiretroviral therapies and laboratory exams. After hardly two-year treatment, the mortality rate of the sub-sample examined dropped by nearly 80%. Both compliance and adverse reactions have shown to be similar to the reported levels in developed countries. This program is unprecedented in Mozambique and has proved extremely effective for the affected population.

Although the depletion of CD4 T cells remains the most reliable marker for estimating the degree of immunosuppression in HIV-1-infected individuals several authors have investigated the possible prognostic and predictive role offered by total lymphocyte count (TLC) as a surrogate of the CD4 cell count in resource-limited settings (RLS). TLC offers the advantages of being less expensive and less complicated than the CD4 cell count. In addition the equipment needed is already available in most RLS. Despite these potential advantages papers recently published on this issue do not demonstrate that TLC fulfils the rigorous requirements as to sensitivity and specificity particularly needed when methods already proved to be accurate detectors of immunosuppression (such as CD4 cell count) are available. The rapid tests for diagnosing HIV infection in adolescents and adults are an example of this having replaced enzyme-linked immunosorbent assay and Western blot in RLS not only because of their lower cost but also because of their good mean sensitivity and specificity (98.5 and 93.4% respectively). The aim of this study was to assess the impact of considering TLC alone on the introduction of antiretroviral therapy in an asymptomatic HIV-infected African population undergoing regular CD4 lymphocyte controls in the framework of a highly active antiretroviral therapy protocol. Moreover the effectiveness of TLC as a marker of immunosuppression was compared with that of another marker the body mass index (BMI) requiring the simple measurement of the anthropometrical parameters of weight and height. (excerpt)

We analyzed single nucleotide polymorphisms in the 5'-untranslated region (-44C/G and -52G/A) of the beta-defensin-1 gene in 78 Mozambican HIV-1-infected mothers. We observed significantly lower levels of HIV-1 RNA in breast milk, but not in plasma, in women with the -52GG genotype versus women with the -52GA and -52AA genotypes, supporting the hypothesis that different expression of beta-defensins could have an impact on viral replication in breast milk.

BackgroundHIV infection is a major contributor to maternal mortality in resource-limited settings. The Drug Resource Enhancement Against AIDS and Malnutrition Programme has been promoting HAART use during pregnancy and postpartum for Prevention-of-mother-to-child-HIV transmission (PMTCT) irrespective of maternal CD4 cell counts since 2002.MethodsRecords for all HIV+ pregnancies followed in Mozambique and Malawi from 6/2002 to 6/2010 were reviewed. The cohort was comprised by pregnancies where women were referred for PMTCT and started HAART during prenatal care (n = 8172, group 1) and pregnancies where women were referred on established HAART (n = 1978, group 2).Results10,150 pregnancies were followed. Median (IQR) baseline values were age 26 years (IQR:23-30), CD4 count 392 cells/mm(3) (IQR:258-563), Viral Load log10 3.9 (IQR:3.2-4.4), BMI 23.4 (IQR:21.5-25.7), Hemoglobin 10.0 (IQR: 9.0-11.0). 101 maternal deaths (0.99%) occurred during pregnancy to 6 weeks postpartum: 87 (1.1%) in group 1 and 14 (0.7%) in group 2. Mortality was 1.3% in women with ConclusionsAntiretrovirals for PMTCT purposes have significant impact on maternal mortality as do CD4 counts and nutritional status. In resource-limited settings, PMTCT programs should provide universal HAART to all HIV+ pregnant women given its impact in prevention of maternal death.