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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Maternal anaemia and duration of zidovudine in antiretroviral regimens for preventing mother-to-child transmission: A randomized trial in three African countries
BMC Infectious Diseases, Volume 13, No. 1, Article 522, Year 2013
Notification
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Description
Background: Although substantiated by little evidence, concerns about zidovudine-related anaemia in pregnancy have influenced antiretroviral (ARV) regimen choice for preventing mother-to-child transmission of HIV-1, especially in settings where anaemia is common.Methods: Eligible HIV-infected pregnant women in Burkina Faso, Kenya and South Africa were followed from 28 weeks of pregnancy until 12-24 months after delivery (n = 1070). Women with a CD4 count of 200-500cells/mm3 and gestational age 28-36 weeks were randomly assigned to zidovudine-containing triple-ARV prophylaxis continued during breastfeeding up to 6-months, or to zidovudine during pregnancy plus single-dose nevirapine (sd-NVP) at labour. Additionally, two cohorts were established, women with CD4 counts: <200 cells/mm3 initiated antiretroviral therapy, and >500 cells/mm3 received zidovudine during pregnancy plus sd-NVP at labour. Mild (haemoglobin 8.0-10.9 g/dl) and severe anaemia (haemoglobin < 8.0 g/dl) occurrence were assessed across study arms, using Kaplan-Meier and multivariable Cox proportional hazards models.Results: At enrolment (corresponded to a median 32 weeks gestation), median haemoglobin was 10.3 g/dl (IQR = 9.2-11.1). Severe anaemia occurred subsequently in 194 (18.1%) women, mostly in those with low baseline haemoglobin, lowest socio-economic category, advanced HIV disease, prolonged breastfeeding (≥6 months) and shorter ARV exposure. Severe anaemia incidence was similar in the randomized arms (equivalence P-value = 0.32). After 1-2 months of ARV's, severe anaemia was significantly reduced in all groups, though remained highest in the low CD4 cohort.Conclusions: Severe anaemia occurs at a similar rate in women receiving longer triple zidovudine-containing regimens or shorter prophylaxis. Pregnant women with pre-existing anaemia and advanced HIV disease require close monitoring. Trial registration number: ISRCTN71468401. © 2013 Sartorius et al.; licensee BioMed Central Ltd.
Authors & Co-Authors
Sartorius, Benn
South Africa, Johannesburg
Wits School of Public Health
South Africa, Durban
University of Kwazulu-natal
Chersich, Matthew Francis
South Africa, Johannesburg
Wits School of Public Health
Belgium, Ghent
Universiteit Gent
Mwaura, Mary
Kenya, Mombasa
International Centre for Reproductive Health Kenya
Méda, Nicolas Yelbomkan
Burkina Faso, Ouagadougou
Centre Muraz
Temmerman, Marleen I.L.
Belgium, Ghent
Universiteit Gent
Newell, Marie Louise
South Africa, Durban
University of Kwazulu-natal
Farley, Timothy M.M.
Switzerland, Nyon
Sigma3 Services Sàrl
Luchters, Stanley M.F.
South Africa, Johannesburg
Wits School of Public Health
Belgium, Ghent
Universiteit Gent
Australia, Melbourne
Burnet Institute
Dioulasso, Bobo
Unknown Affiliation
Faso, Burkina
Unknown Affiliation
Méda, Nicolas T.R.
Unknown Affiliation
Fao, Paulin
Unknown Affiliation
Ky-Zerbo, Odette
Unknown Affiliation
Gouem, Clarisse
Unknown Affiliation
Somda, Paulin Küssome
Unknown Affiliation
Hien, Hervé M.
Unknown Affiliation
Ouédraogo, Patrice Elysée
Unknown Affiliation
Kania, Dramane
Unknown Affiliation
Sanou, Armande K.
Unknown Affiliation
Kossiwavi, Ida Ayassou
Unknown Affiliation
Sanogo, Bintou
Unknown Affiliation
Ouedraogo, Maurice Sidnoma
Unknown Affiliation
Siribié, Issa
Unknown Affiliation
Valéa, Diane C.
Unknown Affiliation
Ouédraogo, Sayouba
Unknown Affiliation
Somé, Roseline
Unknown Affiliation
Rouet, François
Unknown Affiliation
Rollins, Nigel Campbell
Unknown Affiliation
McFetridge, Lynne
Unknown Affiliation
Naidu, Kevindra K.
Unknown Affiliation
Reyners, Marcel
Unknown Affiliation
Irungu, Eunice
Unknown Affiliation
Katingima, Christine
Unknown Affiliation
Ouattara, Gina Muthoni
Unknown Affiliation
Mandaliya, Kishor N.
Unknown Affiliation
Wambua, Sammy
Unknown Affiliation
Thiongo, Mary N.
Unknown Affiliation
Nduati, Ruth W.
Unknown Affiliation
Kose, Judith
Unknown Affiliation
Njagi, E. N.
Unknown Affiliation
Mwaura, Peter Njuguna
Unknown Affiliation
Newell, Marie Louise
Unknown Affiliation
Mepham, Stephen O.
Unknown Affiliation
Viljoen, Johannes I.
Unknown Affiliation
Bland, Ruth M.
Unknown Affiliation
Mthethwa, Londiwe
Unknown Affiliation
Statistics
Citations: 46
Authors: 46
Affiliations: 7
Identifiers
Doi:
10.1186/1471-2334-13-522
e-ISSN:
14712334
Research Areas
Infectious Diseases
Maternal And Child Health
Sexual And Reproductive Health
Study Design
Cohort Study
Study Locations
Burkina Faso
Kenya
South Africa
Participants Gender
Female