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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
18-Month effectiveness of short-course antiretroviral regimens combined with alternatives to breastfeeding to prevent HIV mother-to-child transmission
PLoS ONE, Volume 3, No. 2, Article e1645, Year 2008
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Description
Objective: We assessed the 18-month effectiveness of short-course (sc) antiretroviral peripartum regimens combined with alternatives to prolonged breastfeeding to prevent mother-to-child transmission (MTCT) of HIV-1 in Abidjan, Côte d'Ivoire. Methodology: HIV-1 infected pregnant women received from ≥32-36 weeks of gestation scZidovudine (ZDV)+/ - Lamivudine (3TC)+single-dose Nevirapine (sdNVP) at delivery within the ANRS 1201/1202 DITRAME-Plus cohort (2001-2003). Neonates received a sdNVP+7-day ZDV prophylaxis. Two infant-feeding interventions were systematically offered free of charge: formula-feeding or exclusive shortened breastfeeding with early cessation from four months. The reference group was the ANRS 049a DITRAME cohort (1994-2000) exposed to scZDV from 36 weeks, then to prolonged breastfeeding. Pediatric HIV infection was defined by a positive plasma HIV-1 RNA at any age, or if aged ≥ 18 months, a positive HIV-1 serology. Turnbull estimates of cumulative transmission risks (CTR) and effectiveness (HIV-free survival) were compared by exposure group using a Cox model. Findings: Among 926 live-born children enrolled, 107 (11.6%) were HIV-infected at 18 months. CTRs were 22.3% (95% confidence interval [CI]: 16-30%) in the 238 ZDV long-term breastfed reference group, 15.9% (Cl: 10-27%) in the 169 ZDV+sdNVP shortened breastfed group; 9.4% (Cl:6-14%) in the 195 ZDV+sdNVP formula-fed group; 6.8% (Cl:4-11%) in the 198 ZDV+3TC+sdNVP shortened breastfed group, and 5.6% (Cl:2-10%) in the 126 ZDV+3TC+sdNVP formula-fed group. Each combination had a significantly higher effectiveness than the ZDV long-term breastfed group except for ZDV+sdNVP shortened breastfed children, ranging from 51% (Cl:20-70%) for ZDV+sdNVP formula fed children to 63% (Cl:40-80%) for ZDV+3TC+NVPsd shortened breastfed children, after adjustment for maternal eligibility for antiretroviral therapy (ART), home delivery and low birth-weight. Substantial MTCT risk reductions are reachable in Africa, even in short-term breastfed children. The two sc antiretroviral combinations associated to any of the two infant feeding interventions, formula-feeding and shortened breastfeeding, reduce significantly MTCT with long-term benefit until age 18 months and without increasing mortality. © 2008 Leroy et al.
Authors & Co-Authors
Leroy, Valeriane
France, Paris
Inserm
France, Bordeaux
Université de Bordeaux
Ékouévi, Didier Koumavi
Cote D'ivoire, Abidjan
Centre Hospitalier Universitaire de Treichville
Becquet, Renaud
France, Paris
Inserm
France, Bordeaux
Université de Bordeaux
Viho, Ida
Cote D'ivoire, Abidjan
Centre Hospitalier Universitaire de Treichville
Dequae-Merchadou, Laurence
France, Paris
Inserm
France, Bordeaux
Université de Bordeaux
Tonwe-Gold, Besigin
France, Bordeaux
Université de Bordeaux
Cote D'ivoire, Abidjan
Centre Hospitalier Universitaire de Treichville
Rouet, François
Cote D'ivoire, Abidjan
Centre Hospitalier Universitaire de Treichville
Sakarovitch, Charlotte
France, Paris
Inserm
France, Bordeaux
Université de Bordeaux
Horo, Apollinaire
Cote D'ivoire, Abidjan
Centre Hospitalier Universitaire de Yopougon
Timité-Konan, Marguerite
Cote D'ivoire, Abidjan
Centre Hospitalier Universitaire de Yopougon
Rouzioux, Christine
France, Paris
Hôpital Necker Enfants Malades
Dabis, Franćois Ç.Ois
France, Paris
Inserm
France, Bordeaux
Université de Bordeaux
Welffens-Ekra, Christiane
Unknown Affiliation
Béquet, Laurence
Unknown Affiliation
Allou, Gérard
Unknown Affiliation
Castetbon, Katia
Unknown Affiliation
Touchard, Dominique
Unknown Affiliation
Amani-Bossé, Clarisse
Unknown Affiliation
Ayékoé, Ignace Adou
Unknown Affiliation
Bédikou, Gédéon
Unknown Affiliation
Coulibaly, Nacoumba
Unknown Affiliation
Danel, Christine
Unknown Affiliation
Fassinou, Patricia
Unknown Affiliation
Horo, Apollinaire Gninlgninrin
Unknown Affiliation
Likikouët, Ruffin
Unknown Affiliation
Toure, Hassan
Unknown Affiliation
Inwoley, André
Unknown Affiliation
Touré, Ramata
Unknown Affiliation
Aka-Dago, Hortense
Unknown Affiliation
Sihé, Alphonse
Unknown Affiliation
Agbo, Hélène
Unknown Affiliation
Brou, Hermann
Unknown Affiliation
Desgrées-du-Loû, Annabel
Unknown Affiliation
Tijou-Traoré, Annick
Unknown Affiliation
Zanou, Benjamin
Unknown Affiliation
Blanche, Stéphane
Unknown Affiliation
Delfraissy, Jean François
Unknown Affiliation
Lepage, Philippe
Unknown Affiliation
Mandelbrot, Laurent
Unknown Affiliation
Salamon, Roger L.
Unknown Affiliation
Statistics
Citations: 46
Authors: 40
Affiliations: 6
Identifiers
Doi:
10.1371/journal.pone.0001645
e-ISSN:
19326203
Research Areas
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Study Locations
Ivory Coast
Participants Gender
Female