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Title: Perinatal Antiretroviral Intensification to Prevent Intrapartum HIV Transmission When Antenatal Antiretroviral Therapy Is Initiated Less Than 8 Weeks Before Delivery
Authors: Marc Lallemant
Billy Amzal
Patumrat Sripan
Saïk Urien
Tim R. Cressey
Nicole Ngo-Giang-Huong
Virat Klinbuayaem
Boonsong Rawangban
Prapan Sabsanong
Thitiporn Siriwachirachai
Tapnarong Jarupanich
Prateep Kanjanavikai
Phaiboon Wanasiri
Suporn Koetsawang
Gonzague Jourdain
Sophie Le Coeur
Université de Paris
INED Institut National d' Études Démographiques
Harvard T.H. Chan School of Public Health
Hatyai Hospital
Banglamung Hospital
Kasetsart University
Thailand Ministry of Public Health
Khon Kaen Regional Hospital
Mahidol University
Chiang Mai University
LASER Analytica
Paris Centre Descartes Necker Cochin
Institut de recherche pour le développement (IRD) UMI 174-PHPT
Keywords: Medicine
Issue Date: 1-Jul-2020
Citation: Journal of acquired immune deficiency syndromes (1999). Vol.84, No.3 (2020), 313-322
Abstract: 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 2·2% (95% credibility interval 0·5-6·1) without intensification versus 0·3% (0·0-1·6) with intensification. The probability of superiority of intensification over standard of care was 94·4%. 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.
ISSN: 19447884
Appears in Collections:Scopus 2020

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