16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

18-MONTH EFFECTIVENESS OF SHORT-COURSE PERINATAL ANTIRETROVIRAL REGIMENS COMBINED TO INFANT-FEEDING INTERVENTIONS FOR PMTCT IN ABIDJAN, CÔTE D'IVOIRE. DITRAME PLUS ANRS 1201/1202 2001 – 2005

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. ThAc0101

Leroy V.¹, Ekouévi D.K.², Dequae-Merchadou L.¹, Viho I.², Becquet R.¹, Tonwe-Gold B.², Rouet F.³, Horo A.⁴, Sakarovitch C.¹, Timité-Konan M.⁵, Dabis F.¹, Toni T.³, DITRAME PLUS ANRS 1201/1202 Study Group
¹ INSERM Unité 593, Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Victor Segalen Bordeaux2, Bordeaux, France, ² Projet DITRAME PLUS ANRS 1201/1202, Programme PACCI, Centre Hospitalier Universitaire de Treichville, Abidjan, Cote D'Ivoire, ³ Centre de Diagnostic et de Recherches sur le SIDA (CeDReS), Centre Hospitalier Universitaire de Treichville, Abidjan, Cote D'Ivoire, ⁴ Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire de Yopougon, Abidjan, Cote D'Ivoire, ⁵ Service de Pédiatrie, Centre Hospitalier Universitaire de Yopougon, Abidjan, Cote D'Ivoire

BACKGROUND: We assessed the 18-month effectiveness of two short-course antiretroviral regimens combined to infant-feeding options offered subsequently for PMTCT of HIV-1 in Abidjan, Côte d'Ivoire.

METHODS: Any HIV-1-infected pregnant woman, age ≥ 18, who received a perinatal PMTCT antiretroviral prophylaxis ≥ 32 – 36 weeks of gestation (ZDV ± 3TC + single dose nevirapine [sdNVP]) was eligible if she gave a live-birth. Two infant-feeding interventions were systematically proposed prenatally: formula-feeding (free of charge), or exclusive breastfeeding with early cessation from four months. Blood samples for HIV-diagnosis were taken at Day 2, Week 4 – 6, Month 3, then three monthly until 18 months or two months after stopping breastfeeding if any. Pediatric HIV infection was defined as a positive PCR at any age, or if aged > 18 months, a positive HIV serology. Postnatal transmission (PT) was defined as a child with a negative HIV-1 PCR from a sample obtained at age > 30 days who later became infected; other being peri-partum infection. Cumulative transmission risks (CRs) of infection were estimated using Turnbull method in each infant-feeding group defined at Day 2.

RESULTS: Between March 6^th, 2001 and July 31^st, 2003, 711 live-born children were enrolled of whom 24 were excluded: 22 HIV-indeterminate (3%) and 2 not classified for infant-feeding modalities. At 18 months, 60 children were HIV-infected of whom 12 (20%) were PT (1 in the formula-fed group): CRs were 0.17 (95%CI: 0.099 – 0.307) in the 168 ZDV+sdNVP breastfed group; 0.09 (95%CI: 0.057 – 0.136) in the 195 ZDV+sdNVP formula-fed group; 0.068 (95%CI: 0.0358 – 0.105) in the 198 ZDV+3TC+sdNVP breastfed group, and 0.053 (95%CI: unavailable) in the 126 ZDV+3TC+sdNVP formula-fed group. Overall, low maternal CD4 count (<500) and ZDV+sdNVP regimen (reference: ZDV+3TC+sdNVP) were both significantly associated with long-term infection while having been ever breastfed was not a determinant.

CONCLUSIONS: A combination of perinatal ZDV+3TC+sdNVP associated to infant-feeding interventions reduces significantly MTCT of HIV with long-term benefit until age 18 months.

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2006-08-13
ThAc0101

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