Acceptability and impact of zidovudine for prevention of mother-to-child human immunodeficiency virus–1 transmission in France

Mayaux, Marie-Jeanne; Teglas, Jean-Paul; Mandelbrot, Laurent; Berrébi, Alain; Gallais, H; Matheron, Sophie; Ciraru-Vigneron, N; Parnet-Mathieu, F; Bongain, A.; Rouzioux, Christine; Delfraissy, Jean‐François; Blanche, Stéphane

doi:10.1016/s0022-3476(97)70033-7

Cited by 115 publications

(51 citation statements)

References 13 publications

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“…31 To determine the range of acceptance rates for the sensitivity analysis, we used acceptance rates from women who came for services to the Chicago Department of Public Health Sexually Transmitted Disease Clinics and were offered HIV testing 32 and acceptance rates from other published reports in the medical literature. [33][34][35][36][37] The acceptance of AZT by pregnant women after they are told their HIV status is based on estimates from published studies and results obtained from the University of Illinois Women's Health Clinic 14,38,39 (M. Vajaranant, personal communication, August 1998).…”

Section: Probability Estimatesmentioning

confidence: 99%

Cost-Effectiveness of Universal Compared With Voluntary Screening for Human Immunodeficiency Virus Among Pregnant Women in Chicago

et al. 2000

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ABSTRACT.Objectives. To determine and compare the cost-effectiveness of implementing 3 screening strategies to detect human immunodeficiency virus (HIV) infection among pregnant women in Chicago, Illinois: no screening, voluntary screening, and universal screening.Methods. A decision-analysis model was developed, using standard cost-effectiveness analysis from a societal perspective. Reference case estimates were derived from a surveillance project conducted by the Illinois Department of Public Health and studies were published in the medical literature. Costs included direct and indirect medical costs associated with identification of pregnant women infected with HIV and identification, prevention, and treatment of perinatally HIV-infected newborns. Specifically, for each screening option, the cost per pregnant woman screened, the resulting number of pediatric HIV infections, and the number of newborn life-years were calculated. All costs were adjusted to the 1997 dollar value and discounted at 3%. Sensitivity analyses were determined for all variables included in the decision model.Results. The estimated prevalence of HIV infection among pregnant women in Chicago is .41%. For every 100 000 pregnant women, it is estimated that 104.6 children would be infected with HIV if no screening strategy were implemented and 44.8 children would be infected if voluntary HIV testing (assuming a 92.7% acceptance rate) were available. In comparison, if universal HIV testing was performed, the number of children infected with HIV would decrease to 40 cases. Sensitivity analysis across a maternal HIV prevalence rate of .01% to 2.2% found that universal screening would be cost-saving in communities where the seroprevalence is .21%. In Chicago, it would take an estimated 5.2 months of screening pregnant women to avert 1 case of pediatric HIV. Taking into consideration the lifetime costs of treating a child with HIV infection, universal HIV testing of 100 000 pregnant women would result in a cost-savings of $3.69 million when compared with no screening, and $269 445 when compared with voluntary screening. We estimated that it would cost $11.1 million to screen 100 000 pregnant women in Chicago. The cost-savings produced with increased screening are the direct result of reduced cases of newborns infected with HIV. A 2-way sensitivity analysis was performed to examine how costs vary as a function of the voluntary rates for HIV-positive and HIVnegative women. When screening falls below 50% for HIV-positive mothers, universal screening becomes cheaper than voluntary screening even if no HIV-negative mothers were screened.Conclusion. Reference case analyses showed that universal HIV screening of pregnant women in Chicago would both decrease the number of HIV-infected newborns and save money in comparison to voluntary or no testing strategies. Sensitivity analysis was robust across all variables for the conclusion that universal screening was more effective than voluntary screening. For many communities that have HIV prevalence rates for...

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Section: Probability Estimatesmentioning

confidence: 99%

Cost-Effectiveness of Universal Compared With Voluntary Screening for Human Immunodeficiency Virus Among Pregnant Women in Chicago

et al. 2000

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“…Thus, with the low baseline transmission risks suggested by these studies, it is difficult to determine whether prophylactic cesarean delivery would be a protective adjunct to combination drug therapy. French investigators in the European trial 30 decided to withdraw from the study after calculating that, given the current low rate of perinatal transmission observed in their patients receiving zidovudine monotherapy, 11 demonstration of the postulated 50% reduction in HIV transmission attributed to cesarean delivery would require a prohibitively large enrollment. Indeed, if the rate of transmission among patients receiving combination therapy were as low as 2% and could be reduced to 1% with prophylactic cesarean delivery, a clinical trial with 80% power to demonstrate this difference would require randomization of nearly 5000 patients.…”

Section: Evidence On Use Of Prophylactic Cesarean Deliverymentioning

confidence: 99%

“…We would counsel most HIV-infected pregnant women in the United States and other developed nations that if their HIV disease is well controlled and the viral load is suppressed with combination therapy, there is no evidence that prophylactic cesarean delivery would reduce the risk of vertical transmission beyond the already low rates associated with combination agents. For those receiving zidovudine monotherapy, we would counsel that the risk of transmission is moderate (approximately 5%) 11,12 and that the data are only suggestive that prophylactic cesarean delivery would be of protective benefit. Particularly relevant for women not receiving any antiretroviral therapy would be a discussion of the randomized trial evidence for a substantial reduction in transmission risk associated with prophylactic cesarean delivery.…”

Section: Counseling Pregnant Women With Hiv Infectionmentioning

confidence: 99%

Prophylactic Cesarean Delivery for the Prevention of Perinatal Human Immunodeficiency Virus Transmission

Stringer

Rouse²,

Goldenberg³

1999

JAMA

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“…El esquema más utilizado en nuestro estudio fue de 2 INTR + 1 IP (70%), dando prioridad a zidovudine, pues fue la primera droga que demostró utilidad en la reducción de la transmisión perinatal, y con la que existe mayor experiencia (6,11,12).…”

Section: Discussionunclassified

Ausencia De Transmisión Perinatal De Vih en 40 Embarazadas Tratadas Con Terapia Anti-Retroviral De Alta Potencia

Carmona

C³

et al. 2004

Rev. chil. obstet. ginecol.

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RESUMENObjetivo. Evaluar la magnitud de la transmisión perinatal de VIH, en embarazadas infectadas tratadas con terapia anti-retroviral de alta potencia y los efectos secundarios materno-perinatal. Pacientes y método. Se estudian 40 embarazadas VIH (+) controladas en las Universidades Católicas de Chile y de Lovaina, Bélgica, en el período 1999 -2003. Todas recibieron terapia anti-retroviral de alta potencia. Se les permitió parto vaginal a las que tenían carga viral menor a 1000 copias/ml al final del tercer trimestre. Se determinó la presencia de infección en el recién nacido, mediante técnica de PCR, con un seguimiento mínimo de 6 meses. Resultados. El 70% inició tratamiento a las 24 semanas de gestación. No hubo efectos adversos que requiriesen suspensión del tratamiento. El 30% tenía carga viral menor a 1000 copias/ml en el primer trimestre aumentando a 97,5% al momento del parto con la terapia. No hubo casos de transmisión perinatal (seguimiento 6 meses -3 años). Hubo una muerte neonatal por prematurez (27 semanas). El 50% de las pacientes tuvo parto vaginal. Conclusión. La terapia antiretroviral de alta potencia logró una efectiva profilaxis de la transmisión perinatal (cero por ciento de TPN en nuestra serie). El parto vaginal en aquellas que tienen carga viral menor de 1000 copias/ml no modificó ese riesgo. No hubo efectos adversos significativos por el tratamiento. PALABRAS CLAVE: Embarazo, VIH, terapia anti-retroviral SUMMARYObjective. Assess the rate of perinatal transmission of HIV, in pregnant patients who receive highly active antiretroviral therapy (HAART), and maternal and perinatal side effects. Patients and method. Forty pregnant women with HIV infection attended during 1999 to 2003 period at Catholic University of Chile and Saint Luc University Hospital of Belgium are included. All of them received HAART therapy. A vaginal delivery was proposed only for patients who had a viral load of 1000 copies/ml or less at end of third trimester. The presence of HIV infection in newborns and infants was detected by PCR. Newborns had a follow up of 6 month as minimum. Results. 70% of patients started the therapy at 24 weeks of gestation. There were not serious side effects, enough to suspend the therapy. Only a 30% had a viral load less than 1000 copies/ml at the first trimester and increased to 95% at delivery with HAART. There Trabajos Originales * Trabajo leído en la sesión del martes 7 de septiembre de 2004 de la Sociedad Chilena de Obstetricia y Ginecología.

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Acceptability and impact of zidovudine for prevention of mother-to-child human immunodeficiency virus–1 transmission in France

Cited by 115 publications

References 13 publications

Cost-Effectiveness of Universal Compared With Voluntary Screening for Human Immunodeficiency Virus Among Pregnant Women in Chicago

Cost-Effectiveness of Universal Compared With Voluntary Screening for Human Immunodeficiency Virus Among Pregnant Women in Chicago

Prophylactic Cesarean Delivery for the Prevention of Perinatal Human Immunodeficiency Virus Transmission

Ausencia De Transmisión Perinatal De Vih en 40 Embarazadas Tratadas Con Terapia Anti-Retroviral De Alta Potencia

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