Vaginal lavage with chlorhexidine during labour to reduce mother-to-child HIV transmission: clinical trial in Mombasa, Kenya.
OBJECTIVE
To evaluate the effect of vaginal lavage with diluted chlorhexidine on mother-to child transmission of HIV (MTCT) in a breastfeeding population.


METHODS
This prospective clinical trial was conducted in a governmental hospital in Mombasa, Kenya. On alternating weeks, women were allocated to non-intervention or to intervention consisting of vaginal lavage with 120 ml 0.2% chlorhexidine, later increased to 0.4%, repeated every 3 h from admission to delivery. Infants were tested for HIV by DNA polymerase chain reaction within 48 h and at 6 and 14 weeks of life.


RESULTS
Enrolment and follow-up data were available for 297 and 309 HIV-positive women, respectively, in the non-lavage and the lavage groups. There was no evidence of a difference in intrapartum MTCT (17.2 versus 15.9%, OR 0.9, 95% CI 0.6-1.4) between the groups. Lavage solely before rupture of the membranes tended towards lower MTCT with chlorhexidine 0.2% (OR 0.6, 95% CI 0.3-1.1), and even more with chlorhexidine 0.4% (OR 0.1, 95% CI 0.0-0.9).


CONCLUSIONS
The need remains for interventions reducing MTCT without HIV testing, often unavailable in countries with a high prevalence of HIV. Vaginal lavage with diluted chlorhexidine during delivery did not show a global effect on MTCT in our study. However, the data suggest that lavage before the membranes are ruptured might be associated with a reduction of MTCT, especially with higher concentrations of chlorhexidine.
International Centre for Reproductive Health, University of Ghent, Belgium.
P
P
Gaillard
F
F
Mwanyumba
C
C
Verhofstede
P
P
Claeys
V
V
Chohan
E
E
Goetghebeur
K
K
Mandaliya
J
J
Ndinya-Achola
M
M
Temmerman
D000328:Adult; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D001942:Breast Feeding; D002710:Chlorhexidine / Q000008:administration & dosage / Q000627:therapeutic use*; D036861:Delivery, Obstetric; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission*; D006679:HIV Seropositivity / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control* / Q000706:statistics & numerical data; D007630:Kenya; D007743:Labor, Obstetric; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology*; D007507:Therapeutic Irrigation; D013997:Time Factors; D014621:Vagina
D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine