Clinically significant anemia in HIV-infected pregnant women in India is not a major barrier to zidovudine use for prevention of maternal-to-child transmission.
OBJECTIVE
To determine the prevalence of anemia (serum hemoglobin <10 g/dL) and assess zidovudine use and toxicity in HIV-positive pregnant women in India.


METHODS
From 2002 through 2006, 24,105 pregnant women in Pune were screened for HIV and anemia. As part of an infant prevention of mother-to-child transmission (PMTCT) trial, enrolled HIV-positive women (n = 467) were assessed for anemia and associated outcomes, comparing women receiving zidovudine for >or=2 weeks versus no zidovudine.


RESULTS
The prevalence of anemia was 38.7% in HIV-positive women. Anemic women were as likely as nonanemic women to receive zidovudine. At delivery, regardless of anemia status at enrollment, women receiving >or=2 weeks of zidovudine were 70% less likely to be anemic compared with women receiving no zidovudine (odds ratio = 0.28, 95% confidence interval: 0.14 to 0.57; P < 0.01), received iron and folic acid supplements for longer periods, and had no increased adverse delivery or newborn birth outcomes.


CONCLUSIONS
A significant proportion of HIV-positive pregnant women in India present for antenatal care with anemia. With concurrent iron and folic acid supplementation, however, zidovudine use is not associated with persistent or worsening anemia or associated adverse outcomes. In Indian community settings, all pregnant HIV-positive women should receive early anemia treatment. Mild anemia should not limit zidovudine use for PMTCT in India.
Sinha
Gita
G
Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. gsinha1@jhmi.edu
Choi
Tou J
TJ
Nayak
Uma
U
Gupta
Amita
A
Nair
Sandeep
S
Gupte
Nikhil
N
Bulakh
Pandurang M
PM
Sastry
Jayagowri
J
Deshmukh
Sanjay D
SD
Khandekar
Medha M
MM
Kulkarni
Vandana
V
Bhosale
Ramesh A
RA
Bharucha
Kapila E
KE
Phadke
Mrudula A
MA
Kshirsagar
Anandini S
AS
Bollinger
Robert C
RC
D000328:Adult; D000740:Anemia / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D007194:India / Q000453:epidemiology; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007501:Iron / Q000627:therapeutic use; D011247:Pregnancy; D015215:Zidovudine / Q000008:administration & dosage* / Q000494:pharmacology*
D015215:Zidovudine; D005492:Folic Acid; D007501:Iron