A Trial of Shortened Zidovudine Regimens to Prevent Mother-to-Child Transmission of Human Immunodeficiency Virus Type 1

Lallemant, Marc; Jourdain, Gonzague; Cœur, Sophie Le; Kim, S.; Koetsawang, Suporn; Comeau, Anne Marie; Phoolcharoen, Wiput; Essex, Max; McIntosh, Kenneth; Vithayasai, Vicharn

doi:10.1056/nejm200010053431401

Cited by 374 publications

(100 citation statements)

References 14 publications

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“…This is consistent with the finding of Lallemant et al, 24 in which it was demonstrated that mothers exposed to AZT for a lengthy period experienced more neonatal complications than those exposed for a short period. The findings of this study suggest that pregnant women may have taken AZT for a greater duration when continuing to a later gestation, which, in turn, caused a higher prevalence of anaemia.…”

Section: Resultssupporting

confidence: 93%

An exploration of anaemia in low-birthweight infants exposed to perinatal zidovudine at the neonatal unit at a regional hospital in Durban

Hanley

Ross

2014

South African Family Practice

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Objective: The objective of the study was to determine the prevalence and degree of anaemia in low-birthweight neonates exposed to intrauterine zidovudine (AZT) at a regional hospital neonatal unit in Durban. Design: This was a descriptive, cross-sectional study. Background: Perinatal exposure to AZT has been shown to cause anaemia in full-term babies. The effects of AZT in this group need to be established as there is a low-birthweight rate of 12.8% of anaemia in South Africa. Outcome measures: Outcomes measures of the study were the neonatal haemoglobin (Hb) levels, gestational age and duration of AZT exposure. Results: The total prevalence of anaemia was 47% in the 95 neonatal birth records analysed. The prevalence of anaemia was 16.7% and a mean Hb of 17 g/dl in the 26-to 28-week gestational age category; a prevalence of anaemia of 37% with a mean Hb of 16 g/dl in the 29-to 31-week category; and a prevalence of 54.8% of anaemia with a mean Hb of 17 g/dl in the > 31-week category. The mean Hb in the neonates exposed to more than 28 days of AZT was lower than that in neonates exposed to less than 28 days in the 29-to 31-week and > 31-week gestational age categories. Conclusion:The haematological side-effects of neonatal anaemia resulting from intrauterine AZT exposure were mild and clinically insignificant in keeping with existing international and continental studies. The severity of anaemia in low-birthweight neonates appears to be the same as that in neonates with a normal birthweight. Current recommendations for the routine use of AZT for the prevention of mother-to-child transmission (PMTCT) of HIV are adequate, but further research involving larger numbers is needed.

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Section: Resultssupporting

confidence: 93%

An exploration of anaemia in low-birthweight infants exposed to perinatal zidovudine at the neonatal unit at a regional hospital in Durban

Hanley

Ross

2014

South African Family Practice

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“…To estimate the risk of transmission among late arrivals for ANC who get AZT treatment less than 4 weeks in regimen A, we apply an odds ratio of 1.40 (95% CI 0.82 to 2.38) found in a Thai study [24] comparing the risk of transmission between a short (from 36 weeks onwards) and long (from 28 weeks) maternal course of AZT. In the absence of evidence of the efficacy of regimen D started after 28 weeks but before 36 weeks of gestation, we assume the same efficacy if treatment is started before 34 weeks, and the lower efficacy of regimen A for those starting after 34 weeks.…”

Section: Design and Methodsmentioning

confidence: 99%

Cost-effectiveness of models for prevention of vertical HIV transmission – voluntary counseling and testing and choices of drug regimen

Teerawattananon

Vos

Tangcharoensathien

et al. 2005

Cost Eff Resour Alloc

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Objectives: From a health care provider prospective, to assess the cost-effectiveness of four Antiretroviral therapy (ART) regimens given in addition to voluntary counselling and testing (VCT) for preventing mother-to-child transmission of HIV: a) Zidovudine (AZT); b) Nevirapine (NVP); c) a combination of AZT for early antenatal attenders and NVP for late arrivals; and d) combined administration of AZT and NVP and to assess the incremental cost-effectiveness of adding a second VCT session in late pregnancy. Design & Setting:We examine a hypothetical cohort of 100,000 pregnancies as a decision model. Cost and outcome parameters are estimated as they would apply under Thai routine health service conditions. Effectiveness probabilities are based on best available evidence, from systematic reviews where possible. The main outcome is the number of cases of paediatric HIV averted. Results:The combining administration of AZT and NVP is the most cost-effective drug option. One VCT session with AZT+NVP averts 337 cases of infection at 556 USD per case averted, while two VCT with the same drug regimen averts 16 additional cases at cost of 1,266 USD per infection averted. The incremental cost-effectiveness ratio of moving from 1VCT, AZT+NVP to 2VCT, AZT+NVP is 16,000 USD per additional averted case, which is much lower than the recommended threshold value for HIV infection averted in Thailand. Multivariate uncertainty analysis supports the findings, showing that at a threshold of 35,000 USD, 2VCT, AZT+NVP is preferable to other VCT and drug strategies. Conclusion:Interventions for preventing mother-to-child transmission of HIV are cost-effective. Further costs and negative effects of drug resistance, are unlikely to outweigh the social benefits of reduce transmission of HIV. This model suggests that the new drug regimen is a cost-effective option in the Thai health system at currently accepted thresholds for adopting health technologies.

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“…3, in Ab hän gig keit von der Aus gangsvi rus last, den CD4-Zel len und der Dau er der Zi do vu din ga be [10]. Die Wirk sam keit ei ner Zi do vu din mo no pro phy la xe zur Verrin ge rung der ver ti ka len HIV-Trans mis sion konn te mitt ler wei le in meh re ren gro ßen Stu di en ge zeigt wer den [11,12]. > Kom bi na ti ons the ra pi en zeig ten eine Re duk ti on der ma ter no fe ta len HIV-Trans mis si on auf <2%…”

Section: Da Ten La Ge Und Stu DI Enunclassified

Aspekte der HIV-Therapie in der Schwangerschaft

Krosigk¹,

Jäger²

2005

Gynäkologe

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On li ne pub li ziert: 22. Juli 2005 © Sprin ger Me di zin Ver lag 2005 Abb. 1 9 Ver hält nis der Trans mis si ons ra te zur ma ter na len Vi rus last zum Zeit punkt der Ge burt Redaktion U. Häu fi ge HIV-as so zi ier te und op por tu nis ti sche Er kran kun gen (CDC B und C/AIDS; mod. nach [9]) Krank hei ten Kli ni sches Er schei nungs bild The ra pie Re zi di vie ren der Her pes la bia lis, ano ge ni ta lis Ju cken de, ggf. schmer zen de Hautrö tung mit Bläs chen Lo kal the ra pie, bei Ul ze ra ti on Acic lo vir oral Her pes zos ter Meist schmerz haft Acic lo vir oral/i.v. CMV-Re ti ni tis Seh feld ein schrän kung, dunk le "Punk te" Gan cic lo vir i.v., an schlie ßend oral Ora ler Soor, Soorö so pha gi tis Weiß li che ab streif ba re Be lä ge Sys te misch Flu co na zol oder Itra co na zol Tu ber ku lo se Ver schlech te rung des All ge mein zu stands, Fie ber Stan dard the ra pie, kein Strep to my cin Aty pi sche My ko b ac te rio se Etham bu tol + Azi thro my cin + Ri fa bu tin Re zi di vie ren de bak te ri el le Pneu mo ni en Hus ten, Fie ber, Ver schlech te rung des All ge mein zu stands Amoxy cla vu lan Ma kro li de Pneu mo cys tis-ca ri nii-Pneu mo nie Be las tungs dyspnoe, tro ckener Hus ten, ggf. LDH-An stieg Co trim for te ® Ze re bra le To xo plas mo se Kopf schmer zen, Schwin del, mo to ri sche bzw. sen so ri sche Stö run gen Spi ra my cin im Wech sel mit Py ri me tha min + Sul fa dia zin + Fo lin säu re (nach Sche ma) Ta bel le 6Trans mis si ons ra ten bei un be han del ten Mut ter-KindPaa ren. (Nach [9])

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A Trial of Shortened Zidovudine Regimens to Prevent Mother-to-Child Transmission of Human Immunodeficiency Virus Type 1

Cited by 374 publications

References 14 publications

An exploration of anaemia in low-birthweight infants exposed to perinatal zidovudine at the neonatal unit at a regional hospital in Durban

An exploration of anaemia in low-birthweight infants exposed to perinatal zidovudine at the neonatal unit at a regional hospital in Durban

Cost-effectiveness of models for prevention of vertical HIV transmission – voluntary counseling and testing and choices of drug regimen

Aspekte der HIV-Therapie in der Schwangerschaft

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