title: Twenty-four month efficacy of a maternal short-course zidovudine regimen to prevent mother-to-child transmission of HIV-1 in West Africa.
abstract: OBJECTIVE
  To assess the 24 month efficacy of a maternal short-course zidovudine regimen to prevent mother-to-child transmission (MTCT) of HIV-1 in a breastfeeding population in West Africa.
  
  
  METHODS
  Data were pooled from two clinical trials: DITRAME-ANRS049a conducted in Abidjan, Côte d'Ivoire and Bobo-Dioulasso, Burkina-Faso and RETRO-CI, conducted in Abidjan. Between September 1995 and February 1998, consenting HIV-1-seropositive women were randomly assigned to receive zidovudine (300 mg) or placebo: one tablet twice daily from 36-38 weeks' gestation until delivery, then in DITRAME only, for 7 more days. Paediatric HIV-1 infection was defined as a positive HIV-1 polymerase chain reaction, or if aged > or =15 months, a positive HIV-1 serology. Cumulative risks (CR) of infection were estimated using a competing risk approach with weaning as a competing event.
  
  
  RESULTS
  Among 662 live-born children, 641 had at least one HIV-1 test. All but 12 children were breastfed. At 24 months, overall CR of MTCT were 0.225 in the zidovudine and 0.302 in the placebo group, a 26% significant reduction. Among children born to women with CD4 cell counts < 500/ml at enrollment, CR of MTCT were similar, 0.396 in the zidovudine and 0.413 in the placebo group. Among children born to women with CD4 cell counts > or =500/ml, CR of MTCT were 0.091 in the zidovudine and 0.220 in the placebo group, a significant 59% reduction.
  
  
  CONCLUSIONS
  A maternal short-course zidovudine regimen reduces MTCT of HIV-1 at age 24 months, despite prolonged breastfeeding. However, efficacy was observed only among women with CD4 cell counts > or =500/ml. New interventions should be considered to prevent MTCT, especially for African women with advanced HIV-1 immunodeficiency.
authors.affiliation: Unité INSERM 330, Université Victor Segalen Bordeaux 2, 146 rue Léo Saignat, 33076 Bordeaux Cedex, France. valeriane.leroy@isped.u-bordeaux2.fr
authors.forename: Valériane
authors.initials: V
authors.lastname: Leroy
authors.forename: John M
authors.initials: JM
authors.lastname: Karon
authors.forename: Ahmadou
authors.initials: A
authors.lastname: Alioum
authors.forename: Ehounou R
authors.initials: ER
authors.lastname: Ekpini
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meda
authors.forename: Alan E
authors.initials: AE
authors.lastname: Greenberg
authors.forename: Philippe
authors.initials: P
authors.lastname: Msellati
authors.forename: Michael
authors.initials: M
authors.lastname: Hudgens
authors.forename: François
authors.initials: F
authors.lastname: Dabis
authors.forename: Stefan Z
authors.initials: SZ
authors.lastname: Wiktor
mesh_terms: D000354:Africa, Western; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D015497:HIV-1; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D009035:Mothers; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D015215:Zidovudine / Q000627:therapeutic use*
chemical_list: D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors; D015215:Zidovudine