Maternal HIV-1 disease progression 18-24 months postdelivery according to antiretroviral prophylaxis regimen (triple-antiretroviral prophylaxis during pregnancy and breastfeeding vs zidovudine/single-dose nevirapine prophylaxis): the Kesho Bora randomized controlled trial
Auteurs & affiliatie
Nicolas Meda, Paulin Fao, Odette Ky-Zerbo, Clarisse Gouem, Paulin Somda, Hervé Hien, Patrice Elysée Ouedraogo, Dramane Kania, Armande Sanou, Ida Ayassou Kossiwavi, Bintou Sanogo, Moussa Ouedraogo, Issa Siribie, Diane Valéa, Sayouba Ouedraogo, Roseline Somé, François Rouet, Nigel Rollins, Lynne McFetridge, Kevi Naidu, Stanley Lüchters, Marcel Reyners, Eunice Irungu, Christine Katingima, Mary Mwaura, Gina Ouattara, Kishor Mandaliya, Sammy Wambua, Mary Thiongo, Ruth Nduati, Judith Kose, Ephantus Njagi, Peter Mwaura, Marie-Louise Newell, Stephen Mepham, Johannes Viljoen, Ruth Bland, Londiwe Mthethwa, Brigitte Bazin, Claire Rekacewicz, Allan Taylor, Nicole Flowers, Michael Thigpen, Mary Glenn Fowler, Denise Jamieson, Lynne M Mofenson, Jennifer S Read, Kirsten Bork, Cécile Cames, Amandine Cournil, Patricia Claeys, Marleen Temmerman, Philippe Van de Perre, Pierre Becquart, Vincent Foulongne, Michel Segondy, Isabelle de Vincenzi, Philippe Gaillard, Tim Farley, Ndema Habib, Sihem Landoulsi
Abstract
Background. Antiretroviral (ARV) prophylaxis effectively reduces mother-to-child transmission of human immunodeficiency virus type 1 (HIV). However, it is unclear whether stopping ARVs after breastfeeding cessation affects maternal HIV disease progression. We assessed 18-24-month postpartum disease progression risk among women in a randomized trial assessing efficacy and safety of prophylactic maternal ARVs. Methods. From 2005 to 2008, HIV-infected pregnant women with CD4(+) counts of 200-500/mm(3) were randomized to receive either triple ARV (zidovudine, lamivudine, and lopinavir/ritonavir during pregnancy and breastfeeding) or AZT/sdNVP (zidovudine until delivery with single-dose nevirapine without postpartum prophylaxis). Maternal disease progression was defined as the combined endpoint of death, World Health Organization clinical stage 4 disease, or CD4(+) counts of <200/mm(3). Results. Among 824 randomized women, 789 had at least 1 study visit after cessation of ARV prophylaxis. Following delivery, progression risk up to 24 months postpartum in the triple ARV arm was significantly lower than in the AZT/sdNVP arm (15.7% vs 28.3%; P = .001), but the risks of progression after cessation of ARV prophylaxis (rather than after delivery) were not different (15.0% vs 13.8% 18 months after ARV cessation). Among women with CD4(+) counts of 200-349/mm(3) at enrollment, 24.0% (95% confidence interval [CI], 15.7-35.5) progressed with triple ARV, and 23.0% (95% CI, 17.8-29.5) progressed with AZT/sdNVP, whereas few women in either arm (<5%) with initial CD4(+) counts of >= 350/mm(3) progressed. Conclusions. Interrupting prolonged triple ARV prophylaxis had no effect on HIV progression following cessation (compared with AZT/sdNVP). However, women on triple ARV prophylaxis had lower progression risk during the time on triple ARV. Given the high rate of progression among women with CD4(+) cells of <350/mm(3), ARVs should not be discontinued in this group.
Publicatiedatum:
2012
Teamleden:
Stanley Luchters
Marleen Temmerman
Link naar publicatie
Bijlages
Maternal_HIV-1.pdf (restricted)Gerelateerde publicaties
Joseph Vyankandondera, Sammy Wambua, Eunice Irungu, Kishorchandra Mandaliya, Marleen Temmerman, Claire Ryan, Yasmin Mohamed, Davy Vanden Broeck, Rita Verhelst, Matthew Chersich, Stanley Lüchters
2010 Association of HIV infection with distribution and viral load of HPV types in Kenya: a survey with 820 female sex workersStanley Lüchters, Davy Vanden Broeck, Matthew Chersich, Annalene Nel, Wim Delva, Kishor Mandaliya, Christophe Depuydt, Patricia Claeys, John-Paul Bogers, Marleen Temmerman
2013 Transmission of carcinogenic human papillomavirus types from mother to child: a meta-analysis of published studiesMireille Merckx, Liesbeth Wildero - Van Wouwe, Marc Arbyn, Joris Meys, Steven Weyers, Marleen Temmerman, Davy Vanden Broeck