Sartorius B.K.D., Chersich M.F., Mwaura M., Meda N., Temmerman M., Newell M.L., Farley T.M.M., Luchters S., Cournil Amandine, et al. (2013). Maternal anaemia and duration of zidovudine in antiretroviral regimens for preventing mother-to-child transmission : a randomized trial in three African countries. BMC Infectious Diseases, 13 (1), 522 [14 p.]. ISSN 1471-2334.
Titre du document
Maternal anaemia and duration of zidovudine in antiretroviral regimens for preventing mother-to-child transmission : a randomized trial in three African countries
Année de publication
2013
Auteurs
Sartorius B.K.D., Chersich M.F., Mwaura M., Meda N., Temmerman M., Newell M.L., Farley T.M.M., Luchters S., Cournil Amandine, et al.
Source
BMC Infectious Diseases, 2013,
13 (1), 522 [14 p.] ISSN 1471-2334
Background: Although substantiated by little evidence, concerns about zidovudine-related anaemia in pregnancy have influenced antiretroviral (ARV) regimen choice for preventing mother-to-child transmission of HIV-1, especially in settings where anaemia is common. Methods: Eligible HIV-infected pregnant women in Burkina Faso, Kenya and South Africa were followed from 28 weeks of pregnancy until 12-24 months after delivery (n = 1070). Women with a CD4 count of 200 500cells/mm(3) and gestational age 28-36 weeks were randomly assigned to zidovudine-containing triple-ARV prophylaxis continued during breastfeeding up to 6-months, or to zidovudine during pregnancy plus single-dose nevirapine (sd-NVP) at labour. Additionally, two cohorts were established, women with CD4 counts: <200 cells/mm(3) initiated antiretroviral therapy, and >500 cells/mm(3) received zidovudine during pregnancy plus sd-NVP at labour. Mild (haemoglobin 8.0-10.9 g/dl) and severe anaemia (haemoglobin < 8.0 g/dl) occurrence were assessed across study arms, using Kaplan-Meier and multivariable Cox proportional hazards models. Results: At enrolment (corresponded to amedian 32 weeks gestation), median haemoglobin was 10.3 g/dl (IQR = 9.2-11.1). Severe anaemia occurred subsequently in 194 (18.1%) women, mostly in those with low baseline haemoglobin, lowest socio-economic category, advanced HIV disease, prolonged breastfeeding (>= 6 months) and shorter ARV exposure. Severe anaemia incidence was similar in the randomized arms (equivalence P-value = 0.32). After 1-2months of ARV's, severe anaemia was significantly reduced in all groups, though remained highest in the low CD4 cohort. Conclusions: Severe anaemia occurs at a similar rate in women receiving longer triple zidovudine-containing regimens or shorter prophylaxis. Pregnant women with pre-existing anaemia and advanced HIV disease require close monitoring.
Plan de classement
Maladies sexuellement transmissibles [052MALTRA03]
;
Aspects physiologiques et médicaux [054PHYMED]
Localisation
Fonds IRD [F B010093247]
Identifiant IRD
fdi:010093247
