Leroy Valériane, Ekouevi Didier K, Becquet Renaud, Viho Ida, Dequae-Merchadou Laurence, Tonwe-Gold Besigin, Rouet François, Sakarovitch Charlotte, Horo Appolinaire, Timité-Konan Marguerite, Rouzioux Christine, Dabis François
French National Institute for Health and Medical Research (INSERM), Unité 897, Centre de recherche "Epidémiologie et Biostatistique", Bordeaux, France.
PLoS One. 2008 Feb 20;3(2):e1645. doi: 10.1371/journal.pone.0001645.
We assessed the 18-month effectiveness of short-course (sc) antiretroviral peripartum regimens combined with alternatives to prolonged breastfeeding to prevent mother-to-child transmission (MTCT) of HIV-1 in Abidjan, Côte d'Ivoire.
HIV-1 infected pregnant women received from >/=32-36 weeks of gestation scZidovudine (ZDV)+/-Lamivudine (3TC)+single-dose Nevirapine (sdNVP) at delivery within the ANRS 1201/1202 DITRAME-Plus cohort (2001-2003). Neonates received a sdNVP+7-day ZDV prophylaxis. Two infant-feeding interventions were systematically offered free of charge: formula-feeding or exclusive shortened breastfeeding with early cessation from four months. The reference group was the ANRS 049a DITRAME cohort (1994-2000) exposed to scZDV from 36 weeks, then to prolonged breastfeeding. Pediatric HIV infection was defined by a positive plasma HIV-1 RNA at any age, or if aged >/=18 months, a positive HIV-1 serology. Turnbull estimates of cumulative transmission risks (CTR) and effectiveness (HIV-free survival) were compared by exposure group using a Cox model.
Among 926 live-born children enrolled, 107 (11.6%) were HIV-infected at 18 months. CTRs were 22.3% (95% confidence interval[CI]:16-30%) in the 238 ZDV long-term breastfed reference group, 15.9% (CI:10-27%) in the 169 ZDV+sdNVP shortened breastfed group; 9.4% (CI:6-14%) in the 195 ZDV+sdNVP formula-fed group; 6.8% (CI:4-11%) in the 198 ZDV+3TC+sdNVP shortened breastfed group, and 5.6% (CI:2-10%) in the 126 ZDV+3TC+sdNVP formula-fed group. Each combination had a significantly higher effectiveness than the ZDV long-term breastfed group except for ZDV+sdNVP shortened breastfed children, ranging from 51% (CI:20-70%) for ZDV+sdNVP formula fed children to 63% (CI:40-80%) for ZDV+3TC+NVPsd shortened breastfed children, after adjustment for maternal eligibility for antiretroviral therapy (ART), home delivery and low birth-weight. Substantial MTCT risk reductions are reachable in Africa, even in short-term breastfed children. The two sc antiretroviral combinations associated to any of the two infant feeding interventions, formula-feeding and shortened breastfeeding, reduce significantly MTCT with long-term benefit until age 18 months and without increasing mortality.
我们评估了短疗程抗逆转录病毒围产期治疗方案联合替代长期母乳喂养的方法在科特迪瓦阿比让预防HIV-1母婴传播（MTCT）的18个月有效性。
HIV-1感染的孕妇在妊娠≥32 - 36周时开始接受齐多夫定（ZDV）+/-拉米夫定（3TC）+单剂量奈韦拉平（sdNVP）治疗，并在分娩时给药，该研究纳入了ANRS 1201/1202 DITRAME-Plus队列（2001 - 2003年）。新生儿接受单剂量奈韦拉平+7天的齐多夫定预防治疗。系统地免费提供两种婴儿喂养干预措施：配方奶喂养或从4个月起提前停止的纯母乳喂养。参照组为ANRS 049a DITRAME队列（1994 - 2000年），该队列从36周起接受短疗程齐多夫定治疗，然后进行长期母乳喂养。儿童HIV感染定义为任何年龄时血浆HIV-1 RNA呈阳性，或年龄≥18个月时HIV-1血清学呈阳性。使用Cox模型比较暴露组的累积传播风险（CTR）和有效性（无HIV生存）的Turnbull估计值。
在纳入的926名活产儿童中，107名（11.6%）在18个月时感染了HIV。238名接受ZDV长期母乳喂养的参照组CTR为22.3%（95%置信区间[CI]：16 - 30%），169名接受ZDV + sdNVP缩短母乳喂养组的CTR为15.9%（CI：10 - 27%）；195名接受ZDV + sdNVP配方奶喂养组的CTR为9.4%（CI：6 - 14%）；198名接受ZDV + 3TC + sdNVP缩短母乳喂养组的CTR为6.8%（CI：4 - 11%），126名接受ZDV + 3TC + sdNVP配方奶喂养组的CTR为5.6%（CI：2 - 10%）。除了接受ZDV + sdNVP缩短母乳喂养的儿童外，每种组合的有效性均显著高于ZDV长期母乳喂养组，在调整了母亲接受抗逆转录病毒治疗（ART）的资格、在家分娩和低出生体重因素后，接受ZDV + sdNVP配方奶喂养儿童的有效性为51%（CI：20 - 70%），接受ZDV + 3TC + NVPsd缩短母乳喂养儿童的有效性为63%（CI：40 - 80%）。即使在短期母乳喂养的儿童中，非洲也可实现显著降低MTCT风险。与两种婴儿喂养干预措施（配方奶喂养和缩短母乳喂养）中的任何一种相关的两种短疗程抗逆转录病毒组合，均可显著降低MTCT，并在18个月龄前具有长期益处，且不会增加死亡率。
