title: 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.
abstract: 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.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. gsinha1@jhmi.edu
authors.forename: Gita
authors.initials: G
authors.lastname: Sinha
authors.forename: Tou J
authors.initials: TJ
authors.lastname: Choi
authors.forename: Uma
authors.initials: U
authors.lastname: Nayak
authors.forename: Amita
authors.initials: A
authors.lastname: Gupta
authors.forename: Sandeep
authors.initials: S
authors.lastname: Nair
authors.forename: Nikhil
authors.initials: N
authors.lastname: Gupte
authors.forename: Pandurang M
authors.initials: PM
authors.lastname: Bulakh
authors.forename: Jayagowri
authors.initials: J
authors.lastname: Sastry
authors.forename: Sanjay D
authors.initials: SD
authors.lastname: Deshmukh
authors.forename: Medha M
authors.initials: MM
authors.lastname: Khandekar
authors.forename: Vandana
authors.initials: V
authors.lastname: Kulkarni
authors.forename: Ramesh A
authors.initials: RA
authors.lastname: Bhosale
authors.forename: Kapila E
authors.initials: KE
authors.lastname: Bharucha
authors.forename: Mrudula A
authors.initials: MA
authors.lastname: Phadke
authors.forename: Anandini S
authors.initials: AS
authors.lastname: Kshirsagar
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bollinger
mesh_terms: 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*
chemical_list: D015215:Zidovudine; D005492:Folic Acid; D007501:Iron