%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Lallemant, Marc
%A Amzal, B.
%A Sripan, P.
%A Urien, S.
%A Cressey, T. R.
%A Ngo-Giang-Huong, Nicole
%A Klinbuayaem, V.
%A Rawangban, B.
%A Sabsanong, P.
%A Siriwachirachai, T.
%A Jarupanich, T.
%A Kanjanavikai, P.
%A Wanasiri, P.
%A Koetsawang, S.
%A Jourdain, Gonzague
%A Le Coeur, S.
%T Perinatal antiretroviral intensification to prevent intrapartum HIV transmission when antenatal antiretroviral therapy is initiated less than 8 weeks before delivery
%D 2020
%L fdi:010079321
%G ENG
%J JAIDS : Journal of Acquired Immune Deficiency Syndromes
%@ 1525-4135
%K HIV ; prevention of mother-to-child transmission ; Bayesian design ; antiretroviral therapy ; clinical trial ; historical control ; meta-analysis ; Thailand
%K THAILANDE
%M ISI:000546317200013
%N 3
%P 313-322
%R 10.1097/qai.0000000000002350
%U https://www.documentation.ird.fr/hor/fdi:010079321
%> https://www.documentation.ird.fr/intranet/publi/2020/08/010079321.pdf
%V 84
%W Horizon (IRD)
%X Introduction: Infants born to women living with HIV initiating combination antiretroviral therapy (cART) late in pregnancy are at high risk of intrapartum infection. Mother/infant perinatal antiretroviral intensification may substantially reduce this risk. Methods: In this single-arm Bayesian trial, pregnant women with HIV receiving standard of care antiretroviral prophylaxis in Thailand (maternal antenatal lopinavir-based cART; nonbreastfed infants 4 weeks' postnatal zidovudine) were offered "antiretroviral intensification" (labor single-dose nevirapine plus infant zidovudine-lamivudine-nevirapine for 2 weeks followed by zidovudine-lamivudine for 2 weeks) if their antenatal cART was initiated <= 8 weeks before delivery. A negative birth HIV-DNA polymerase chain reaction (PCR) followed by a confirmed positive PCR defined intrapartum transmission. Before study initiation, we modeled intrapartum transmission probabilities using data from 3738 mother/infant pairs enrolled in our previous trials in Thailand using a logistic model, with perinatal maternal/infant antiretroviral regimen and predicted viral load at delivery as main covariates. Using the characteristics of the women enrolled who received intensification, prior intrapartum transmission probabilities (credibility intervals) with/without intensification were estimated. After including the transmission data observed in the current study, the corresponding Bayesian posterior transmission probability was derived. Results: No intrapartum transmission of HIV was observed among the 88 mother/infant pairs receiving intensification. The estimated intrapartum transmission probability was 2 center dot 2% (95% credibility interval 0 center dot 5-6 center dot 1) without intensification versus 0 center dot 3% (0 center dot 0-1 center dot 6) with intensification. The probability of superiority of intensification over standard of care was 94 center dot 4%. Antiretroviral intensification appeared safe. Conclusion: Mother/infant antiretroviral intensification was effective in preventing intrapartum transmission of HIV in pregnant women receiving <= 8 weeks antepartum cART.
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