%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Sripan, P.
%A Le Coeur, Sophie
%A Amzal, B.
%A Ingsrisawang, L.
%A Traisathit, P.
%A Ngo-Giang-Huong, Nicole
%A McIntosh, K.
%A Cressey, T. R.
%A Sangsawang, S.
%A Rawangban, B.
%A Kanjanavikai, P.
%A Treluyer, J. M.
%A Jourdain, Gonzague
%A Lallemant, Marc
%A Urien, S.
%T Modeling of in-utero and intra-partum transmissions to evaluate the efficacy of interventions for the prevention of perinatal HIV
%D 2015
%L fdi:010064660
%G ENG
%J Plos One
%@ 1932-6203
%K THAILANDE
%M ISI:000354918600038
%N 5
%P e0126647 [16 ]
%R 10.1371/journal.pone.0126647
%U https://www.documentation.ird.fr/hor/fdi:010064660
%> https://horizon.documentation.ird.fr/exl-doc/pleins_textes/divers17-08/010064660.pdf
%V 10
%W Horizon (IRD)
%X Background Antiretroviral treatments decrease HIV mother-to-child transmission through pre/post exposure prophylaxis and reduction of maternal viral load. We modeled in-utero and intra-partum HIV transmissions to investigate the preventive role of various antiretroviral treatments interventions. Methods We analysed data from 3,759 women-infant pairs enrolled in 3 randomized clinical trials evaluating (1) zidovudine monotherapy, (2) zidovudine plus perinatal single-dose nevirapine or (3) zidovudine plus lopinavir/ritonavir for the prevention of mother-to-child transmission of HIV in Thailand. All infants were formula-fed. Non-linear mixed effect modeling was used to express the viral load evolution under antiretroviral treatments and the probability of transmission. Results Median viral load was 4 log(10) copies/mL (Interquartile range: 3.36-4.56) before antiretroviral treatments initiation. An Emaxmodel described the viral load time-course during pregnancy. Half of the maximum effect of zidovudine (28% decrease) and lopinavir/ritonavir (72% decrease) were achieved after 98 and 12 days, respectively. Adjusted on viral load at baseline (Odds ratio = 1.50 [95% confidence interval: 1.34, 1.68] per log(10) copies/mL increment), anti-retroviral treatments duration (OR = 0.80 [0.75, 0.84] per week increment) but not the nature of antiretroviral treatments were associated with in-utero transmission. Adjusted on gestational age at delivery (<37 weeks, OR = 2.37 [1.37, 4.10]), baseline CD4 (Odds ratio = 0.79 [0.72, 0.88] per 100 cells/mm(3) increment) and predicted viral load at delivery (OR = 1.47 [1.25, 1.64] per log(10) copies/mL increment), single-dose nevirapine considerably reduced intra-partum transmission (OR = 0.32 [0.2, 0.51]). Conclusion These models determined the respective contributions of various antiretroviral strategies on prevention of mother-to-child transmission. This can help predict the efficacy of new antiretroviral treatments and/or prevention of mother-to-child transmission strategies particularly for women with no or late antenatal care who are at high risk of transmitting HIV to their offspring.
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