Postnatal transmission of HIV-1 after a maternal short-course zidovudine peripartum regimen in West Africa
Postnatal transmission of HIV-1 after a maternal short-course zidovudine peripartum regimen in West Africa
复制标题
DOI：
10.1097/00002030-200307040-00010
复制
发表时间：
2003-07-04
期刊：
影响因子：
3.8
通讯作者：
Wiktor, SZ
中科院分区：
文献类型：
--
作者：
Leroy, V;Karon, JM;Wiktor, SZ
背景资料：为了评估产后传播（PT）的HIV-1的风险后，产妇短期齐多夫定方案在母乳喂养population.Methods：数据汇总从两个试验：ANRS 049 a DITRAME（阿比让，科特迪瓦和波波-迪乌拉索，布基纳法索）和RETROCI（阿比让）。1995年9月至1998年2月，妊娠36-38周的HIV-1血清阳性孕妇随机接受口服齐多夫定或安慰剂：一片，每日两次，直至分娩，并仅接受DITRAME，持续7天以上。PT病例是年龄大于或等于30天时HIV-1 PCR阴性的儿童感染，随后感染定义为HIV-1 PCR阳性，或如果年龄大于或等于15个月，则为HIV血清学阳性。PT的累积风险（CR）计算使用竞争风险的方法与断奶作为竞争events.Findings：在24个月的年龄，PT的CR是相似的齐多夫定（9.8%，n = 254）和安慰剂组（9.1%，n = 225）。在PT风险因素的多变量模型中，治疗效果不显着，与CD 4细胞计数大于或等于500 x 10（6）/l的女性相比，入组时母体CD 4细胞计数< 500 x 10（6）/l的风险增加了两倍[风险比（HR），3.14; 95%置信区间（CI），1.31 - 7.49]以及入组时母体血浆病毒载量增加（HR，1 log（10）增加为2.65; CI，1.75-4.00）。两组之间PT发生率相似，因此降低了24个月时围产期齐多夫定方案的长期总体疗效。CD 4细胞计数低的妇女中PT的风险较高，强调了确定干预措施以预防这些妇女PT的重要性。(C)2003年利平科特威廉姆斯威尔金斯。
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, Cote 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. A PT case was infection in a child with a negative HIV-1 PCR at age greater than or equal to 30 days who later became infected as defined by a positive HIV-1 PCR, or if aged greater than or equal to 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 PT were 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 x 10(6)/l at entry tripled the hazard compared to women with CD4 cell counts greater than or equal to 500 x 10(6)/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 log(10) 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. (C) 2003 Lippincott Williams Wilkins.