Medical Advocates for Social Justice
Conference Abstract
from the
2nd IAS Conference on HIV and Pathogenesis
Paris, France

July 14-17, 2003
 

 

Effectiveness of a Short Course of Zidovudine + Lamivudine and
Peripartum Nevirapine to Prevent HIV-1 Mother-to-Child Transmission
[Abstract 219]

F Dabis, DK Ekouévi12, F Rouet, L Bequet3, I Viho2, A Horo4, P Fassinou5,
H Touré2, C Welfens-Ekra6, V Leroy2; ANRS Ditrame Plus Study Group.
 
1.Unité INSERM 593, ISPED, Université Victor Segalen, Bordeaux, France; 2. Projet ANRS
Ditrame Plus, Programme PACCI, Abidjan,Côte d'Ivoir; 3.CeDReS, Programme PACCI, Abidjan,
Côte d'Ivoire; 4.  Service de Gynécologie, CHU de Yopougon, Abidjan, Côte d'Ivoire; 5. Service de
Pédiatrie, CHU de Yopougon, Abidjan, Côte d'Ivoire; 6.  Service de Gynécologie, CHU de Yopougon, Abidjan, Côte d'Ivoire.

 

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Background:
In Africa, short regimens of zidovudine (ZDV) or nevirapine (NVP) have demonstrated their efficacy for PMTCT with 6 week transmission rates of 14 and 12%, respectively. In the first part of the ANRS 1201 trial (March 2001-August 2002), the field efficacy of a short regimen of ZDV + peripartum NTVP was demonstrated (6% transmission rate at 6 weeks).

Methods:
An open-label nonrandomized trial in Abidjan starting in September 2002. Consenting women with HIV infection start oral Combivir [ZDV 300 mg + lamivudine (LAM) 150 mg bid] >=32 weeks of gestation with an oral loading dose of 600 mg ZDV + 150 mg LAM + 200 mg NVP at beginning of labour. The maternal treatment (ZDV+LAM) continued 3 days postpartum. The neonate receives post-exposure prophylaxis for 1 week with ZDV syrup (2 mg/kg/6 h) + a single dose of NVP syrup (2 mg/kg) on day 3. Paediatric HIV infection is diagnosed when plasma HIV viral load is >5000 HIV RNA copies/ml (PCR) at 4 weeks, confirmed at 6 weeks. The reference groups are: 1) the ANRS 049 DITRAME cohort treated with a short regimen of ZDV (36 weeks in a randomized trial ( Lancet 1999) and in the subsequent open-label phase (AIDS 2002); 2) and the first ANRS 1201 Ditrame Plus cohort treated with ZDV+NVP ( CROI 2003).

Results:
From September 2002 to February 2003, 209 HIV+ pregnant women have been included. Median age is 27 years (23-30), median CD4 count is 439/mm (14% <200/mm). As of February 28, 139 women have delivered (137 livebirths and 2 stillbirths). Among 99 children with 4-6 week follow-up, five have been diagnosed with HIV infection. The MTCT rate is 5.0% (95% CI: 1.7-11.4). All HIV infected infants had in utero infection (RNA-positive day 7) and their mother had CD4 <500/mm.

Conclusions:
This preliminary analysis shows that the combination of ZDV+LAM+NVP prevents most peripartum transmission of HIV in Africa. Enrolment is ongoing to confirm efficacy and document safety.
 
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Effectiveness of a Short Course of Zidovudine + Lamivudine and
Peripartum Nevirapine to Prevent HIV-1 Mother-to-Child Transmission
A Medical Advocates for Social Justice Update