title: Use of combination neonatal prophylaxis for the prevention of mother-to-child transmission of HIV infection in European high-risk infants.
abstract: OBJECTIVE
  To evaluate use of combination neonatal prophylaxis (CNP) in infants at high risk for mother-to-child transmission (MTCT) of HIV in Europe and investigate whether CNP is more effective in preventing MTCT than single drug neonatal prophylaxis (SNP).
  
  
  METHODS
  Individual patient-data meta-analysis across eight observational studies.
  
  
  METHODS
  Factors associated with CNP receipt and with MTCT were explored by logistic regression using data from nonbreastfed infants, born between 1996 and 2010 and at high risk for MTCT.
  
  
  RESULTS
  In 5285 mother-infant pairs, 1463 (27.7%) had no antenatal or intrapartum antiretroviral prophylaxis, 915 (17.3%) had only intrapartum prophylaxis and 2907 (55.0%) mothers had detectable delivery viral load despite receiving antenatal antiretroviral therapy. Any neonatal prophylaxis was administered to 4623 (87.5%) infants altogether; 1105 (23.9%) received CNP. Factors significantly associated with the receipt of CNP were later calendar birth year, no elective caesarean section, maternal CD4 cell count less than 200 cells/μl, maternal delivery viral load more than 1000 copies/ml, no antenatal antiretroviral therapy, receipt of intrapartum single-dose nevirapine and cohort. After adjustment, absence of neonatal prophylaxis was associated with higher risk of MTCT compared to neonatal prophylaxis [adjusted odds ratio (aOR) 2.29; 95% confidence interval (95% CI) 1.46-2.59; P < 0.0001]. Further, there was no association between CNP and MTCT compared to SNP (aOR 1.41; 95% CI 0.97-2.5; P = 0.07).
  
  
  CONCLUSIONS
  In this European population, CNP use is increasing and associated with presence of MTCT risk factors. The finding of no observed difference in MTCT risk between one drug and CNP may reflect residual confounding or the fact that CNP may be effective only in a subgroup of infants rather than the whole population of high-risk infants.
authors.affiliation: aDepartment of Sciences for Woman and Child's Health, University of Florence, Anna Meyer Children's University Hospital, Florence bUniversity of Padua, Italy cVictor Babes Hospital, Bucharest, Romania dHôpital St Pierre, Brussels, Belgium eMedical Research Council Clinical Trials Unit, London, UK fDepartment of Statistics, University of Florence, Italy gPerinatal Prevention of AIDS Initiative, Odessa, Ukraine hHospital Sant Joan de Déu-Universitat de Barcelona, Barcelona iHospital Universitario de Getafe, Madrid jHospital 12 de Octubre, Madrid, Spain kUniversität Basel, Switzerland lUniversity College London, UK.
authors.forename: Elena
authors.initials: E
authors.lastname: Chiappini
authors.forename: Luisa
authors.initials: L
authors.lastname: Galli
authors.forename: Carlo
authors.initials: C
authors.lastname: Giaquinto
authors.forename: Luminita
authors.initials: L
authors.lastname: Ene
authors.forename: Tessa
authors.initials: T
authors.lastname: Goetghebuer
authors.forename: Ali
authors.initials: A
authors.lastname: Judd
authors.forename: Catiuscia
authors.initials: C
authors.lastname: Lisi
authors.forename: Ruslan
authors.initials: R
authors.lastname: Malyuta
authors.forename: Antoni
authors.initials: A
authors.lastname: Noguera-Julian
authors.forename: Jose Tomas
authors.initials: JT
authors.lastname: Ramos
authors.forename: Pablo
authors.initials: P
authors.lastname: Rojo-Conejo
authors.forename: Christoph
authors.initials: C
authors.lastname: Rudin
authors.forename: Pat
authors.initials: P
authors.lastname: Tookey
authors.forename: Maurizio
authors.initials: M
authors.lastname: de Martino
authors.forename: Claire
authors.initials: C
authors.lastname: Thorne
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D018890:Chemoprevention / Q000379:methods*; D004359:Drug Therapy, Combination / Q000379:methods; D004363:Drug Utilization / Q000706:statistics & numerical data; D005060:Europe; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents