Routine Use of Combined Zidovudine and Nevirapine Regimen in MTCT-Plus Program

HIVandHepatitis.com Coverage of Highlights from the
3^rd IAS Conference on HIV Pathogenesis and Treatment
July 24 - 27, 2005, Rio de Janerio, Brazil

Recent studies have shown the efficacy of combined zidovudine (AZT: Retrovir) and nevirapine (Viramune) regimens in reducing mother to child transmission (MTCT) rates. A combined regimen has been offered to women included in the French Red-Cross MTCT-Plus pilot program in Pointe-Noire to evaluate the feasibility of this treatment when scaling up this type of program.

Voluntary HIV counselling and testing (VCT) is offered to pregnant women in 7 health centers. Consenting HIV + women get free care and treatment.

Mothers receive either zidovudine (300mg twice daily) starting on 36 weeks’ gestation (28 weeks’ after 10/01/04) up to 1 week after delivery and single-dose intra-partum nevirapine (200mg) or are offered HAART when presenting low CD4 count (<200/mm3) or clinical AIDS.

Adherence to treatment is supported by counseling and patient education. Infants are given zidovudine (4mg/kg twice daily, 7 days) and single-dose nevirapine (2mg/kg). Infants’ HIV-1 status is tested with HIV-1 RNA PCR.

Results

· From 07/11/02 to 12/31/04, of 10497 pregnant women accessing VCT, 9810 had HIV testing and 7502 returned for their result.

· 843 women (8.6 %) were HIV+ and 538 were included in the MTCT cohort.

· 106 women received HAART during pregnancy.

· On 12/31/04, 138 women were lost to follow-up, 321 gave birth under antiretroviral treatment (70 HAART, 209 ZDV+NVP regimens, 42 various antiretroviral regimens). Among infants born with ZDV+NVP regimen, 177 were tested at 1 month and 9 reported + (MTCT rate = 5.1%).

· MTCT rate was lower (p<0.05) when regimen was incomplete (54 infants, 38 tests, 5+ versus 155 complete regimen, 139 tests, 4+).

· 84.5% of infants received formula feeding.

The authors conclude, “In routine MTCT program, combined ZDV + NVP regimen proves to be feasible and effective in reducing MTCT but efficacy is impaired by low adherence to one of the stages. Adherence support through counseling and education should be emphasized even when using short course MTCT regimen.”

French Red Cross, Paris, France, Unité Mère-Enfant, Pointe-Noire, Congo, Maternité Hôpital Sicé, Pointe-Noire, Congo

08/03/05

Reference
O Marcy and others. Routine Use of Combined Zidovudine and Nevirapine Regimen in MTCT-Plus Program. Abstract TuPp0404 (poster). 3^rd IAS Conference on HIV Pathogenesis and Treatment. July 24-27, 2005. Rio de Janeiro, Brazil.

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