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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Postnatal transmission of HIV-1 after a maternal short-course zidovudine peripartum regimen in West Africa
AIDS, Volume 17, No. 10, Year 2003
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Description
Background: To assess the postnatal transmission (PT) risk of HIV-1 after a maternal short-course zidovudine regimen in a breastfeeding population. Methods: Data were pooled from two trials: ANRS 049a DITRAME (Abidjan, Côte d'Ivoire and Bobo-Dioulasso, Burkina-Faso) and RETROCI (Abidjan). Consenting HIV-1 seropositive women were randomized at 36-38 weeks' gestation between September 1995 and February 1998, to receive oral zidovudine or placebo: one tablet twice daily until delivery, and in DITRAME only, for 7 more days. APT case was infection in a child with a negative HIV-1 PCR at age ≥ 30 days who later became infected as defined by a positive HIV-1 PCR, or if aged ≥ 15 months, a positive HIV serology. Cumulative risks (CR) of PT were computed using a competing risk approach with weaning as a competing event. Findings: At age 24 months, CR for PTwere similar in the zidovudine (9.8%, n = 254) and placebo groups (9.1%, n = 225). In a multivariate model of PT risk factors, the treatment effect was not significant, maternal CD4 cell count < 500 × 106/l at entry tripled the hazard compared to women with CD4 cell counts ≥ 500 × 106/l [hazard ratio (HR), 3.14; 95% confidence interval (CI), 1.31-7.49] as well as an increased maternal plasma viral load at entry (HR, 2.65 for 1 log10 increase; CI, 1.75-4.00). Interpretation: PT occurred at a similar rate between arms and therefore reduced the long-term overall efficacy of this peripartum zidovudine regimen at age 24 months. The higher risk of PT among women with low CD4 cell count emphasizes the importance of identifying interventions to prevent PT for these women. © 2003 Lippincott Williams & Wilkins.
Authors & Co-Authors
Leroy, Valeriane
France, Paris
Inserm
Karon, John M.
United States, Atlanta
Centers for Disease Control and Prevention
Alioum, Ahmadou
France, Paris
Inserm
Ekpini, Ehounou René
Cote D'ivoire, Abidjan
Projet Retro-ci
van de Perre, Philippe
Burkina Faso, Bobo-dioulasso
Organisation de Coordination et de Cooperation Pour la Lutte Contre Les Grandes Endemies Bobo-dioulasso
Greenberg, Alan E.
United States, Atlanta
Centers for Disease Control and Prevention
Msellati, Philippe
France, Paris
Inserm
Hudgens, Michael G.
United States, Seattle
Fred Hutchinson Cancer Research Center
Dabis, Franćois Ç.Ois
France, Paris
Inserm
Wiktor, Stefan Zbyszko
United States, Atlanta
Centers for Disease Control and Prevention
Statistics
Citations: 86
Authors: 10
Affiliations: 5
Identifiers
Doi:
10.1097/00002030-200307040-00010
Research Areas
Environmental
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Quasi Experimental Study
Study Locations
Multi-countries
Ivory Coast
Participants Gender
Female