Efficacy of antiretroviral drugs in reducing mother-to-child transmission of HIV in Africa: A meta-analysis of published clinical trials
Efficacy of antiretroviral drugs in reducing mother-to-child transmission of HIV in Africa: A meta-analysis of published clinical trials
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DOI：
10.1089/aid.2007.0291
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发表时间：
2008-06-01
影响因子：
1.5
通讯作者：
Essex, M.
中科院分区：
文献类型：
--
作者：
Chigwedere, Pride;Seage, George R., III;Essex, M.
抗逆转录病毒药物已被证明在减少艾滋病毒母婴传播方面有效。对抗逆转录病毒药物在减少母婴传播方面的疗效进行概括性估计，对于建模和政策决策很重要。然而，迄今为止还没有人试图为非洲这个艾滋病毒/艾滋病负担最重的大陆提出这一简要估计数。这项研究通过对在非洲进行的已发表研究进行荟萃分析，估计抗逆转录病毒药物在减少非洲母婴传播方面的功效。使用先验协议，Medline，EMBASE，和科克伦图书馆进行了初步研究，测量艾滋病毒的母婴传播，有抗逆转录病毒药物作为暴露于母亲，并在非洲进行。提取的数据包括研究特征、人群、质量、暴露和结果。使用随机效应模型分析数据，每个试验组作为数据点。1999年至2007年在西非、东非和南部非洲进行的10项随机临床试验符合纳入标准。他们的样本量从139到1797不等，并使用不同的抗逆转录病毒治疗方案作为母亲产前、产时或产后以及婴儿的暴露量。使用抗逆转录病毒药物的综合效应估计值为4-6周时10.6%（95% CI：8.6-13.1）的传播率，安慰剂组为21.0%（95% CI：15.5-27.7）的传播率。这表示约50%的疗效。结果是稳定的，不受任何单一研究的影响。所有方案均耐受良好。我们的结论是，在非洲使用抗逆转录病毒药物减少艾滋病毒母婴传播是有效的，耐受性良好。
Antiretroviral drugs (ARVs) have been shown to be efficacious in decreasing mother-to-child transmission (MTCT) of HIV. A summary estimate of the efficacy of ARVs in reducing MTCT is important for modeling and policy decisions. However, no one has hitherto attempted to generate this summary estimate for Africa, the continent with the greatest HIV/AIDS burden. This study estimates the efficacy of ARVs in reducing MTCT in Africa through a meta-analysis of published studies conducted in Africa. Using an a priori protocol, Medline, EMBASE, and the Cochrane Library were searched for primary studies that measured MTCT of HIV, had ARVs as the exposure to the mother, and were conducted in Africa. Extracted data included characteristics of the study, population, quality, exposure, and results. The data were analyzed using a random effects model with each trial arm as a data point. Ten randomized clinical trials conducted in West, East, and Southern Africa published from 1999 to 2007 satisfied the inclusion criteria. They ranged in sample size from 139 to 1797, and used different ARV regimens as the exposure to the mother antepartum, intrapartum, or postpartum, and to the baby. The combined effect estimate of using ARVs is 10.6% (95% CI: 8.6-13.1) transmission at 4-6 weeks and 21.0% (95% CI: 15.5-27.7) transmission for placebo. This represents approximately 50% efficacy. The result is stable and not driven by any single study. All regimens were well tolerated. We conclude that ARV use to reduce MTCT of HIV in Africa is efficacious and well tolerated.