Is there a difference in the efficacy of peripartum antiretroviral regimens in reducing mother-to-child transmission of HIV in Africa?
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.
Leroy
Valériane
V
INSERM U. 593, Institut d'Epidémiologie, Santé Publique et Développement (ISPED), Université Victor Segalen Bordeaux 2, Bordeaux, France. valeriane.leroy@isped.u-bordeaux2.fr
Sakarovitch
Charlotte
C
Cortina-Borja
Mario
M
McIntyre
James
J
Coovadia
Hoosen
H
Dabis
Francois
F
Newell
Marie-Louise
ML
Saba
J
J
Gray
G
G
Ndugwa
Ch
Ch
Kilewo
Ch
Ch
Massawe
A
A
Kituuka
P
P
Okong
P
P
Grulich
A
A
von Briesen
H
H
Goudsmit
J
J
Biberfeld
G
G
Haverkamp
G
G
Weverling
G J
GJ
Lange
J M A
JM
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*
D019380:Anti-HIV Agents; D004338:Drug Combinations; D019259:Lamivudine; D015215:Zidovudine