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Field
Efficacy of Zidovudine, Lamivudine and Single-dose Nevirapine to
Prevent Peripartum HIV Transmission
In
Africa, single-dose nevirapine/NVPsd)
(Viramune), short regimens of zidovudine/ZDV
(Retrovir) or ZDV + lamivudine/3TC (Epivir)
are recommended to prevent peripartum mother-to-child HIV transmission
(PMTCT). This group of researchers evaluated the 6-week
field efficacy of two more PMTCT drug combinations in an open-label
intervention cohort in Abidjan.
In
2001-2002, consenting women started oral ZDV 300 mg twice daily
(bid) at >=36 weeks of gestation, with 600 mg of ZDV + 200 mg
NVPsd orally at beginning of labor. In 2002-2003, the antepartum
regimen at >=32 weeks comprised ZDV as previously + 3TC 150 mg
bid; the labor 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.
Pediatric
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 >=
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 live
births were eligible for analysis;
79
children were HIV-infected peripartum.
Six-week
transmission probability was 6.5% with ZDV + NVPsd, a 72% reduction
compared with ZDV alone. It was 4.7% 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.
02/28/05
Reference
ANRS
1201/1202 DITRAME PLUS Study Group. Field efficacy of zidovudine, lamivudine
and single-dose nevirapine to prevent peripartum HIV transmission. AIDS 19(3): 309-318, February
18, 2005.
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