AEGiS-14IAC: Effectiveness of a short course of zidovudine + nevirapine to prevent mother-to-child transmission (PMTCT) of HIV-1: The Ditrame Plus ANRS 1201 Project in Abidjan, Cote d'Ivoire.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Effectiveness of a short course of zidovudine + nevirapine to prevent mother-to-child transmission (PMTCT) of HIV-1: The Ditrame Plus ANRS 1201 Project in Abidjan, Cote d'Ivoire.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. ThOrD1428)

Dabis F, Leroy V, Bequet L, Ekouevi DK, Viho I, Horo A, Timite-Konan M, Welffens-Ekra C
Unite Inserm 330, Universite Bordeaux 2, Bordeaux, France

BACKGROUND: In Africa, short regimens of monotherapy of either zidovudine (ZDV) or nevirapine (NVP) have demonstrated their efficacy for PMTCT. The aim of this study is to evaluate the effectiveness and tolerance of a short regimen of ZDV + NVP for peripartum PMTCT.

METHODS: A non randomized therapeutic cohort in Abidjan, Cote d'Ivoire was initiated in March 2001. Consenting women diagnosed with HIV-1 infection and informed of their serostatus start treatment (ZDV 300 mg bid orally) >= 36 weeks of amenorrhea and no later than beginning of labour when an oral loading dose of 600 mg ZDV and 200 mg of NVP is given. The neonate is treated for one week with a syrup of ZDV (2 mg/kg every 6 hours), and a single dose of syrup of 2 mg/kg of NVP on Day 3. The woman receives a supplementation in multivitamins, iron and folates, and a malaria chemoprohylaxis. Children are diagnosed as having HIV infection when viral load is >5000 HIV RNA copies/ml at 4 weeks measured by branched DNA (Chiron). The reference for comparison will be the pooled cohort treated by a short regimen of ZDV monotherapy beginning at 36 weeks and recruited in two randomized trials in Abidjan and Bobo Dioulasso, ANRS 049 and CDC (N=319, with an estimated six week MTCT rate of 14.7% [Leroy et al. AIDS in press]).

RESULTS: A total of 204 HIV+ pregnant women have been included in the project as of Dec. 31th 2001. Median age was 26 years and median CD4 count 365/mm³ (70% <500/mm³). 171 women delivered 178 children live-births (5 twins and 1 triplet). Eight of the 141 children with four week follow-up have been diagnosed with HIV infection: transmission rate was 5.7% (95% Confidence Interval: 2.5-10.9%). 7/8 transmitting mothers had CD4 <500/mm³. Four neonates (2.2%) died within the first 28 days of life. Enrollment continues up to 400.

CONCLUSIONS: Early findings of the Ditrame Plus project show a low rate of peripartum transmission from mother-to-child with ZDV + Nevirapine.

Keywords: AEGIS, Zidovudine, Nevirapine, HIV-1, HIV Infections, CD4 Lymphocyte Count, Viral Load, Mothers, Cote d'Ivoire, Acquired Immunodeficiency Syndrome, Delivery, Obstetric, Africa, Child, Human, Female, Pregnancy, transmission, surgery

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