Sripan P. auteur aut IRD Le Coeur Sophie auteur aut IRD Amzal B. auteur aut IRD Ingsrisawang L. auteur aut IRD Traisathit P. auteur aut IRD Ngo-Giang-Huong Nicole auteur aut IRD McIntosh K. auteur aut IRD Cressey T. R. auteur aut IRD Sangsawang S. auteur aut IRD Rawangban B. auteur aut IRD Kanjanavikai P. auteur aut IRD Treluyer J. M. auteur aut IRD Jourdain Gonzague auteur aut IRD Lallemant Marc auteur aut IRD Urien S. auteur aut IRD text journalArticle eng text/pdf reformatted digital access 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. specialized THAILANDE 052 050 020 10 5 e0126647 [16 p.] 2015 1932-6203 https://www.documentation.ird.fr/hor/fdi:010064660 10.1371/journal.pone.0126647 1932-6203 [F B010064660] https://www.documentation.ird.fr/hor/fdi:010064660 https://horizon.documentation.ird.fr/exl-doc/pleins_textes/divers17-08/010064660.pdf IRD - Base Horizon / Pleins textes 2015-07-03 2017-09-06 fdi:010064660 fre