title: Is there a difference in the efficacy of peripartum antiretroviral regimens in reducing mother-to-child transmission of HIV in Africa?
abstract: BACKGROUND
  Peripartum antiretroviral regimens have been shown to prevent mother-to-child transmission of HIV (MTCT) in randomized clinical trials; however, direct comparison of published results is impossible given methodological and population differences.
  
  
  OBJECTIVE
  To directly compare the efficacy of different antiretroviral regimens in reducing the risk of 6-week MTCT rate in African breastfeeding populations.
  
  
  METHODS
  Pooled analysis including all mother-infant pairs from any relevant trial: West African ZDV-placebo trials, Petra ZDV+3TC [two regimens A (pre/intra/post-partum) and B (intra/post-partum), placebo from Uganda and Tanzania], SAINT (NVP and Petra arm B), HIVNET012 (NVP, ultra short ZDV pp) and the Vitamin A trial (as placebo arm in South Africa). Peripartum HIV infection was any positive RNA or DNA polymerase chain reaction test < day 60. The MTCT risk was estimated at 6 weeks for each treatment arm and compared with placebo or single-dose NVP using logistic regression adjusting for maternal CD4 cell count, breastfeeding and birthweight.
  
  
  RESULTS
  Overall, 4125 singleton live-births were included; 3629 (88%) were assessed for HIV status at 6 weeks of age. In comparison with placebo, zidovudine + lamivudine (ZDV+3TC) arm A [adjusted odds ratio (AOR), 0.23; P < 0.0001], ZDV+3TC arm B (AOR, 0.49; P < 0.001), antenatal ZDV short (AOR, 0.55; P = 0.006) and nevirapine (NVP) (AOR, 0.60; P = 0.0007) significantly reduced MTCT. In comparison with NVP, only the longest regimen of ZDV+3TC (AOR, 0.39, P < 0.0005) was significantly more effective.
  
  
  CONCLUSIONS
  These results are in line with current World Health Organisation guidelines suggesting equivalence of choice between single-dose NVP and short-course ZDV, and confirm the greater efficacy of ZDV+3TC than with any single antiretroviral drug.
authors.affiliation: INSERM U. 593, Institut d'Epidémiologie, Santé Publique et Développement (ISPED), Université Victor Segalen Bordeaux 2, Bordeaux, France. valeriane.leroy@isped.u-bordeaux2.fr
authors.forename: Valériane
authors.initials: V
authors.lastname: Leroy
authors.forename: Charlotte
authors.initials: C
authors.lastname: Sakarovitch
authors.forename: Mario
authors.initials: M
authors.lastname: Cortina-Borja
authors.forename: James
authors.initials: J
authors.lastname: McIntyre
authors.forename: Hoosen
authors.initials: H
authors.lastname: Coovadia
authors.forename: Francois
authors.initials: F
authors.lastname: Dabis
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Newell
authors.forename: J
authors.initials: J
authors.lastname: Saba
authors.forename: G
authors.initials: G
authors.lastname: Gray
authors.forename: Ch
authors.initials: Ch
authors.lastname: Ndugwa
authors.forename: Ch
authors.initials: Ch
authors.lastname: Kilewo
authors.forename: A
authors.initials: A
authors.lastname: Massawe
authors.forename: P
authors.initials: P
authors.lastname: Kituuka
authors.forename: P
authors.initials: P
authors.lastname: Okong
authors.forename: A
authors.initials: A
authors.lastname: Grulich
authors.forename: H
authors.initials: H
authors.lastname: von Briesen
authors.forename: J
authors.initials: J
authors.lastname: Goudsmit
authors.forename: G
authors.initials: G
authors.lastname: Biberfeld
authors.forename: G
authors.initials: G
authors.lastname: Haverkamp
authors.forename: G J
authors.initials: GJ
authors.lastname: Weverling
authors.forename: J M A
authors.initials: JM
authors.lastname: Lange
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D001942:Breast Feeding / Q000009:adverse effects; D004338:Drug Combinations; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D019259:Lamivudine / Q000008:administration & dosage*; D008297:Male; D018743:Perinatal Care; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D012307:Risk Factors; D016896:Treatment Outcome; D015215:Zidovudine / Q000008:administration & dosage*
chemical_list: D019380:Anti-HIV Agents; D004338:Drug Combinations; D019259:Lamivudine; D015215:Zidovudine