Twenty-four month efficacy of a maternal short-course zidovudine regimen to prevent mother-to-child transmission of HIV-1 in West Africa

Leroy, Valériane; Karon, John M.; Alioum, Ahmadou; Ekpini, Ehounou R.; Méda, Nicolas; Greenberg, Alan E.; Msellati, Philippe; Hudgens, Michael G.; Dabis, François; Wiktor, Stefan Z.

doi:10.1097/00002030-200203080-00016

Cited by 139 publications

(69 citation statements)

References 18 publications

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“…These regimens are widely considered to be similar in efficacy in reducing HIV-1 perinatal transmission [20], however they have not been compared directly in a randomized trial. Transmission risk for zidovudine was higher and for nevirapine was lower in our study than in larger previously published trials of each regimen, but most estimates from previous trials were contained in the 95% CI for our estimates [21][22][23][24]. Although our study was small and not primarily designed to evaluate effects on transmission risk, it suggests that nevirapine may be more effective than short-course zidovudine in decreasing mother-to-child transmission in breastfeeding cohorts and certainly confirms the benefit of this simple regimen.…”

Section: Discussioncontrasting

confidence: 48%

Breast milk HIV-1 suppression and decreased transmission: a randomized trial comparing HIVNET 012 nevirapine versus short-course zidovudine

Chung

Kiarie

Richardson

et al. 2005

Aids

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Objective-To compare the effect of perinatal regimens of short-course nevirapine (HIVNET 012) and zidovudine [Thai-Centers for Disease Control and Prevention (CDC) regimen] on breast milk viral shedding and perinatal transmission during the first 6 weeks postpartum in a randomized clinical trial. Design-Randomized clinical trial.Methods-Pregnant HIV-1 seropositive women in Nairobi, Kenya who planned to breastfeed were randomized to HIVNET 012 or Thai-CDC regimens. Two to four breast milk samples were collected each week between delivery and 6 weeks postpartum. Breast milk HIV-1 RNA was quantified using the Gen-Probe TMA assay. Infants were tested for HIV-1 DNA at birth and 6 weeks. Results-FromMarch to October 2003, 76 women were enrolled and 795 breast milk samples were collected from 60 women who were randomized and followed after delivery. Between 3 and 21 days postpartum, nevirapine was associated with significantly greater suppression of breast milk log 10 HIV-1 RNA: days 3 to 7 (1.98 versus 2.42, P = 0.1); days 8 to 14 (1.78 versus 2.48, P = 0.005); days 15 to 21 (1.90 versus 2.97, P = 0.003). At 6 weeks, the HIV-1 perinatal transmission rate was significantly lower among those who took nevirapine than zidovudine (6.8% versus 30.3%, P = 0.02).Conclusions-Compared to a peripartum zidovudine regimen, nevirapine was significantly more likely to decrease HIV-1 RNA in breast milk during the first week and through the third

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Section: Discussioncontrasting

confidence: 48%

Breast milk HIV-1 suppression and decreased transmission: a randomized trial comparing HIVNET 012 nevirapine versus short-course zidovudine

Chung

Kiarie

Richardson

et al. 2005

Aids

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“…1 Several trials have reported the efficacy of simple, low-cost antiretroviral prophylactic regimens to reduce mother-to-child transmission of HIV in sub-Saharan Africa. [2][3][4] Although prevention of mother-to-child transmission of HIV (PMTCT) interventions using single-dose nevirapine (sdNVP) have been implemented in many urban and rural clinics in Zimbabwe, 5 uptake of these interventions remains low, primarily due to poor antenatal HIV testing rates. 6 Detection of maternal infection early in pregnancy through voluntary counselling and HIV testing (VCT) is critical for PMTCT.…”

Section: Introductionmentioning

confidence: 99%

Routine offer of antenatal HIV testing (“opt-out” approach) to prevent mother-to-child transmission of HIV in urban Zimbabwe

Chandisarewa

Stranix‐Chibanda

Chirapa

et al. 2007

Bull. World Health Organ.

143

169

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Objective To assess the impact of routine antenatal HIV testing for preventing mother-to-child transmission of HIV (PMTCT) in urban Zimbabwe. Methods Community counsellors were trained in routine HIV testing policy using a specific training module from June 2005 through November 2005. Key outcomes during the first 6 months of routine testing were compared with the prior 6-month "opt-in" period, and clients were interviewed. Findings Of the 4551 women presenting for antenatal care during the first 6 months of routine HIV testing, 4547 (99.9%) were tested for HIV compared with 3058 (65%) of 4700 women during the last 6 months of the opt-in testing (P < 0.001), with a corresponding increase in the numbers of HIV-infected women identified antenatally (926 compared with 513, P < 0.001). During routine testing, more HIV-infected women collected results compared to the opt-in testing (908 compared with 487, P < 0.001) resulting in a significant increase in deliveries by HIV-infected women (256 compared with 186, P = 0.001); more mother/infant pairs received antiretroviral prophylaxis (n = 256) compared to the opt-in testing (n = 185); and more mother/infant pairs followed up at clinics (105 compared with 49, P = 0.002). Women were satisfied with counselling services and most (89%) stated that offering routine testing is helpful. HIV-infected women reported low levels of spousal abuse and other adverse social consequences.

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“…5 However, more than 90% of their infants are protected against HIV-1 during pregnancy. 6 The antiretroviral therapy, zidovudine (ZDV) is metabolized into its active form in the placenta. 7 ZDV inhibits HIV replication within placental cells.…”

Section: Introductionmentioning

confidence: 99%

Role of placenta in the vertical transmission of human immunodeficiency virus

2008

J Perinatol

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Twenty-four month efficacy of a maternal short-course zidovudine regimen to prevent mother-to-child transmission of HIV-1 in West Africa

Cited by 139 publications

References 18 publications

Breast milk HIV-1 suppression and decreased transmission: a randomized trial comparing HIVNET 012 nevirapine versus short-course zidovudine

Breast milk HIV-1 suppression and decreased transmission: a randomized trial comparing HIVNET 012 nevirapine versus short-course zidovudine

Routine offer of antenatal HIV testing (“opt-out” approach) to prevent mother-to-child transmission of HIV in urban Zimbabwe

Role of placenta in the vertical transmission of human immunodeficiency virus

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