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Field efficacy of zidovudine, lamivudine and single-dose nevirapine to prevent peripartum HIV transmission.
AIDS 2005; 19(3):309-18AIDS

Abstract

OBJECTIVES

In Africa, single-dose nevirapine (NVPsd), short regimens of zidovudine (ZDV) or ZDV + lamivudine (3TC) are recommended to prevent peripartum mother-to-child HIV transmission (PMTCT). We evaluated the 6-week field efficacy of two more PMTCT drug combinations.

DESIGN

An open-label intervention cohort in Abidjan.

METHODS

In 2001-2002, consenting women started oral ZDV 300 mg twice daily (bid) at > or =36 weeks of gestation, with 600 mg of ZDV + 200 mg NVPsd orally at beginning of labour. In 2002-2003, the antepartum regimen at > or =32 weeks comprised ZDV as previously + 3TC 150 mg bid; the labour dose comprised ZDV + NVPsd as previously + 300 mg 3TC orally. Neonates received ZDV syrup (2 mg/kg per 6 h) for 7 days + NVPsd syrup (2 mg/kg) on day 2 in both periods. Each woman was assisted to either use breast milk substitutes or breastfeed exclusively. Paediatric HIV infection was diagnosed by plasma HIV RNA viral load at 4 weeks, confirmed at 6 weeks. The reference group was a cohort receiving a short regimen of ZDV > or = 36-38 weeks in 1995-2000 in the same population.

RESULTS

A total of 1144 HIV-infected pregnant women were included: 351 with ZDV, 420 with ZDV + NVPsd and 373 with ZDV + 3TC + NVPsd; 1010 livebirths were eligible for analysis; 79 children were HIV-infected peripartum. Six-week transmission probability was 6.5% [95% confidence interval (CI), 3.9-9.1%) with ZDV + NVPsd, a 72% reduction compared with ZDV alone (95% CI, 52-88%; P = 0.0002 adjusted on maternal CD4, clinical stage and breastfeeding). It was 4.7% (95% CI, 2.4-7.0%) with ZDV + 3TC + NVPsd (P = 0.34 compared with ZDV + NVPsd).

CONCLUSIONS

A short-course of ZDV + NVPsd prevents most peripartum HIV transmission in Africa. This regimen could be added to international guidelines.

Authors+Show Affiliations

Unité INSERM 593, Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Victor Segalen, 146 Rue Léo Saignat, 33076 Bordeaux, France. francois.dabis@isped.u-bordeaux2.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15718842

Citation

Dabis, François, et al. "Field Efficacy of Zidovudine, Lamivudine and Single-dose Nevirapine to Prevent Peripartum HIV Transmission." AIDS (London, England), vol. 19, no. 3, 2005, pp. 309-18.
Dabis F, Bequet L, Ekouevi DK, et al. Field efficacy of zidovudine, lamivudine and single-dose nevirapine to prevent peripartum HIV transmission. AIDS. 2005;19(3):309-18.
Dabis, F., Bequet, L., Ekouevi, D. K., Viho, I., Rouet, F., Horo, A., ... Leroy, V. (2005). Field efficacy of zidovudine, lamivudine and single-dose nevirapine to prevent peripartum HIV transmission. AIDS (London, England), 19(3), pp. 309-18.
Dabis F, et al. Field Efficacy of Zidovudine, Lamivudine and Single-dose Nevirapine to Prevent Peripartum HIV Transmission. AIDS. 2005 Feb 18;19(3):309-18. PubMed PMID: 15718842.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Field efficacy of zidovudine, lamivudine and single-dose nevirapine to prevent peripartum HIV transmission. AU - Dabis,François, AU - Bequet,Laurence, AU - Ekouevi,Didier Koumavi, AU - Viho,Ida, AU - Rouet,François, AU - Horo,Apollinaire, AU - Sakarovitch,Charlotte, AU - Becquet,Renaud, AU - Fassinou,Patricia, AU - Dequae-Merchadou,Laurence, AU - Welffens-Ekra,Christiane, AU - Rouzioux,Chrisitine, AU - Leroy,Valériane, AU - ,, PY - 2005/2/19/pubmed PY - 2005/6/10/medline PY - 2005/2/19/entrez SP - 309 EP - 18 JF - AIDS (London, England) JO - AIDS VL - 19 IS - 3 N2 - OBJECTIVES: In Africa, single-dose nevirapine (NVPsd), short regimens of zidovudine (ZDV) or ZDV + lamivudine (3TC) are recommended to prevent peripartum mother-to-child HIV transmission (PMTCT). We evaluated the 6-week field efficacy of two more PMTCT drug combinations. DESIGN: An open-label intervention cohort in Abidjan. METHODS: In 2001-2002, consenting women started oral ZDV 300 mg twice daily (bid) at > or =36 weeks of gestation, with 600 mg of ZDV + 200 mg NVPsd orally at beginning of labour. In 2002-2003, the antepartum regimen at > or =32 weeks comprised ZDV as previously + 3TC 150 mg bid; the labour dose comprised ZDV + NVPsd as previously + 300 mg 3TC orally. Neonates received ZDV syrup (2 mg/kg per 6 h) for 7 days + NVPsd syrup (2 mg/kg) on day 2 in both periods. Each woman was assisted to either use breast milk substitutes or breastfeed exclusively. Paediatric HIV infection was diagnosed by plasma HIV RNA viral load at 4 weeks, confirmed at 6 weeks. The reference group was a cohort receiving a short regimen of ZDV > or = 36-38 weeks in 1995-2000 in the same population. RESULTS: A total of 1144 HIV-infected pregnant women were included: 351 with ZDV, 420 with ZDV + NVPsd and 373 with ZDV + 3TC + NVPsd; 1010 livebirths were eligible for analysis; 79 children were HIV-infected peripartum. Six-week transmission probability was 6.5% [95% confidence interval (CI), 3.9-9.1%) with ZDV + NVPsd, a 72% reduction compared with ZDV alone (95% CI, 52-88%; P = 0.0002 adjusted on maternal CD4, clinical stage and breastfeeding). It was 4.7% (95% CI, 2.4-7.0%) with ZDV + 3TC + NVPsd (P = 0.34 compared with ZDV + NVPsd). CONCLUSIONS: A short-course of ZDV + NVPsd prevents most peripartum HIV transmission in Africa. This regimen could be added to international guidelines. SN - 0269-9370 UR - https://www.unboundmedicine.com/medline/citation/15718842/Field_efficacy_of_zidovudine_lamivudine_and_single_dose_nevirapine_to_prevent_peripartum_HIV_transmission_ L2 - http://Insights.ovid.com/pubmed?pmid=15718842 DB - PRIME DP - Unbound Medicine ER -