KR Damania RH Merchant J Karkare
Mumbai, India
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Various interventions designed to reduce vertical transmission of human immunodeficiency virus (HIV) are reviewed in this issue (see pages 29-39). Here, the authors assessed the effectiveness of a combination of these measures in pregnant Indian women infected with the virus.
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Introduction
Prior to the present study1 being undertaken, the usefulness of zidovudine (AZT) in reducing mother-to-child transmission (MTCT) of HIV had already been proven in the ACTG 076 trial. There also existed circumstantial evidence subsequently substantiated for the benefit of elective caesarean section (ECS) to reduce transmission rates. The risk of HIV transmission through breastfeeding was well documented.
The aim of the study, therefore, was to evaluate the efficacy of a three-pronged intervention strategy based on the above in reducing perinatal transmission of HIV:
1. Antenatal AZT (100 mg four times daily for 6 weeks prior to delivery).
2. ECS at term.
3. No breast feeding; neonatal AZT (12.5 mg twice-daily for 6 weeks).
Patients and Procedures
Three hundred and twenty HIV-infected pregnant women were counselled about choice of intervention(s). Fifty-nine (18.5%) accepted all three interventions (group 1). Of the remainder, 178 (55.6%) did not accept any intervention (group 2), while 83 (25%) accepted one or two interventions (group 3); of the latter, 71% opted for no breastfeeding as the only intervention. In terms of patient characteristics, all three groups were identical.Children were followed-up with HIV antibody testing at 9, 12, and 18 months.
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Results
No children tested seropositive in group 1 compared with just over one-third in group 2 and one-fifth in group 3 (see table 1).
There was a single case of wound evisceration in a patient belonging to group 1. That this woman had an abnormal CD4:CD8 cell count emphasised the need for caution in performing ECS normally a very safe procedure in this institute in immunocompromised individuals.
Conclusions
This preliminary study suggests that a three-pronged intervention strategy to reduce MTCT of HIV is effective. Antenatal AZT in lower dosages and shorter periods may be offered in resource-poor settings.
Reference
1. Damania KR, Merchant RH, Karkare J. A three-pronged strategy to prevent mother to child transmission of HIV infection. Presented at: 42nd All India Congress of Obstetrics and Gynaecology, Hyderabad, India, December 27-30, 1998.
Table 1. Effect of intervention(s) on perinatal HIV transmission rates |
Group
(interventions) |
Transmission rate
[%] (95% CI) |
1 (All)
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0 (0-19) |
2 (None) |
34 (21-49)
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3 (Some) |
21 (7-42)
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Abbreviation: CI = confidence interval.
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