%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Fao, P.
%A Ky-Zerbo, O.
%A Gouem, C.
%A Somda, P.
%A Hien, H.
%A Ouedraogo, P. E.
%A Kania, D.
%A Sanou, A.
%A Kossiwavi, I. A.
%A Sanogo, B.
%A Ouedraogo, M.
%A Siribie, I.
%A Valea, D.
%A Ouedraogo, S.
%A Some, R.
%A Rouet, F.
%A Rollins, N.
%A McFetridge, L.
%A Naidu, K.
%A Luchters, S.
%A Reyners, M.
%A Irungu, E.
%A Katingima, C.
%A Mwaura, M.
%A Ouattara, G.
%A Mandaliya, K.
%A Wambua, S.
%A Thiongo, M.
%A Nduati, R.
%A Kose, J.
%A Njagi, E.
%A Mwaura, P.
%A Newell, M. L.
%A Mepham, S.
%A Viljoen, J.
%A Bland, R.
%A Mthethwa, L.
%A Bazin, B.
%A Rekacewicz, C.
%A Taylor, A.
%A Flowers, N.
%A Thigpen, M.
%A Fowler, M. G.
%A Jamieson, D.
%A Mofenson, L. M.
%A Read, J. S.
%A Bork, Kirsten
%A Cames, Cécile
%A Cournil, Amandine
%A Claeys, P.
%A Temmerman, M.
%A Van de Perre, P.
%A Becquart, Pierre
%A Foulongne, V.
%A Segondy, M.
%A de Vincenzi, I.
%A Gaillard, P.
%A Farley, T.
%A Habib, N.
%A Landoulsi, S.
%T Maternal HIV-1 disease progression 18-24 months postdelivery according to antiretroviral prophylaxis regimen (triple-antiretroviral prophylaxis during pregnancy and breastfeeding vs Zidovudine/single-dose Nevirapine prophylaxis) : the Kesho Bora randomized controlled trial
%D 2012
%L fdi:010056919
%G ENG
%J Clinical Infectious Diseases
%@ 1058-4838
%M ISI:000306364300023
%N 3
%P 449-460
%R 10.1093/cid/cis461
%U https://www.documentation.ird.fr/hor/fdi:010056919
%> https://www.documentation.ird.fr/intranet/publi/depot/2012-09-11/010056919.pdf
%V 55
%W Horizon (IRD)
%X Background. Antiretroviral (ARV) prophylaxis effectively reduces mother-to-child transmission of human immunodeficiency virus type 1 (HIV). However, it is unclear whether stopping ARVs after breastfeeding cessation affects maternal HIV disease progression. We assessed 18-24-month postpartum disease progression risk among women in a randomized trial assessing efficacy and safety of prophylactic maternal ARVs. Methods. From 2005 to 2008, HIV-infected pregnant women with CD4(+) counts of 200-500/mm(3) were randomized to receive either triple ARV (zidovudine, lamivudine, and lopinavir/ritonavir during pregnancy and breastfeeding) or AZT/sdNVP (zidovudine until delivery with single-dose nevirapine without postpartum prophylaxis). Maternal disease progression was defined as the combined endpoint of death, World Health Organization clinical stage 4 disease, or CD4(+) counts of <200/mm(3). Results. Among 824 randomized women, 789 had at least 1 study visit after cessation of ARV prophylaxis. Following delivery, progression risk up to 24 months postpartum in the triple ARV arm was significantly lower than in the AZT/sdNVP arm (15.7% vs 28.3%; P = .001), but the risks of progression after cessation of ARV prophylaxis (rather than after delivery) were not different (15.0% vs 13.8% 18 months after ARV cessation). Among women with CD4(+) counts of 200-349/mm(3) at enrollment, 24.0% (95% confidence interval [CI], 15.7-35.5) progressed with triple ARV, and 23.0% (95% CI, 17.8-29.5) progressed with AZT/sdNVP, whereas few women in either arm (<5%) with initial CD4(+) counts of >= 350/mm(3) progressed. Conclusions. Interrupting prolonged triple ARV prophylaxis had no effect on HIV progression following cessation (compared with AZT/sdNVP). However, women on triple ARV prophylaxis had lower progression risk during the time on triple ARV. Given the high rate of progression among women with CD4(+) cells of <350/mm(3), ARVs should not be discontinued in this group.
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