Gray Glenda, Violari Avye, McIntyre James, Jivkov Boris, Schnittman Steven, Reynolds Laurie, Ledeine Jean-Marie
Perinatal HIV Research Unit, University of the Witwatersrand, South Africa.
J Acquir Immune Defic Syndr. 2006 Jun;42(2):169-76. doi: 10.1097/01.qai.0000219772.74432.20.
This is the first report on the preliminary efficacy of 4 different short-course nucleoside analogue regimens (stavudine [d4T], didanosine [ddI], d4T+ddI, and zidovudine [ZDV]) for the prevention of mother-to-child transmission of HIV-1 (MTCT) in a resource-limited setting.
This prospective open-label, randomized 4-arm study (May 1999 to May 2000) conducted in South Africa enrolled 373 women from 34 weeks of gestation; medication was continued through delivery and for 6 weeks to infants. MTCT rates were ascertained at birth, 6, 12, and 24 weeks of age.
Mean maternal HIV-1 RNA levels decreased rapidly on treatment in all groups. At week 4, the mean decrease was 1.91 log10 copies/mL (c/mL) in the d4T+ddI group, 1.33 log10 c/mL in the ddI group, 1.12 log10 c/mL in the d4T group, and 0.76 log10 c/mL in the ZDV group. Among the 362 evaluable mother-infant pairs, 11 infants in the d4T group, 10 in the ddI group, 5 in the ZDV group, and 4 in the d4T+ddI group were infected by 24 weeks of age. Eleven infections occurred in utero. Treatment with d4T and ddI was not associated with lactic acidosis or hepatic steatosis.
The abbreviated use of nucleoside analogues for the prevention of MTCT appears safe and effective.
这是关于4种不同的短程核苷类似物方案（司他夫定[d4T]、去羟肌苷[ddI]、d4T+ddI和齐多夫定[ZDV]）在资源有限环境中预防HIV-1母婴传播（MTCT）的初步疗效的首份报告。
这项前瞻性开放标签、随机4组研究（1999年5月至2000年5月）在南非进行，纳入了373名孕34周的女性；药物持续至分娩，并给婴儿使用6周。在出生时、6周、12周和24周龄时确定MTCT率。
所有组中，治疗后母亲的HIV-1 RNA平均水平迅速下降。在第4周时，d4T+ddI组平均下降1.91 log10拷贝/毫升（c/mL），ddI组为1.33 log10 c/mL，d4T组为1.12 log10 c/mL，ZDV组为0.76 log10 c/mL。在362对可评估的母婴对中，到24周龄时，d4T组有11名婴儿、ddI组有10名婴儿、ZDV组有5名婴儿、d4T+ddI组有4名婴儿被感染。11例感染发生在子宫内。d4T和ddI治疗与乳酸性酸中毒或肝脂肪变性无关。
短期使用核苷类似物预防MTCT似乎安全有效。
