Mother To Child Transmission

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Focusing On Antiretroviral Therapy For Prevention Of Maternal To Fetal HIV Transmission

Regimens

q       Long Course Zidovudine Treatment

q       Short Course Zidovudine Treatment

q       Combination Therapy

Long Course Zidovudine Treatment

The Trial:

Pediatrics AIDS Clinical Trial Group (PACTG 076)

• Based On A Randomised - Placebo Contolled Trial In France And USA, 1994

• Similar Trial Not Available From India

§       But Data Suggest From Thailand And Brazil Suggest A Good Efficacy Of This Regimen

ü   Women given ZDV (100mg 5times a day) Or Placebo starting at 14-34 weeks (median 26 weeks)

ü   Received ZDV during Labour and Delivery. Newborns received ZDV at 8-12 hours as mentioned above

ü   All mothers had CD4 counts > 200 were symptom free and had not received antiretrovirals before

Results Of The PACTG076 trials

Almost 67% reduction in transmission (356 mother child groups analysed)

References:

AIDS Clinical Trials Group Protocol (Center For Disease Control And Prevention), Recommendations for use of of zidovudine to reduce perinatal transmission of human immunodeficiency virus, MMWR, 1994; 43 (No. RR - 11) I-20

Data From Red Book, American Academy Of Pediatrics, 1997

Data From Who Paper HIV In Pregnancy : A Review

Newell M-L, Gray G, Bryson YJ. Prevention of mother to child HIV - I transmission. AIDS, 1997, 11 (Suppl A) : S165-S172

Certain Limitations When Applied To The Developing Countries:

q       The Study reviewed only non - breast feeding mothers

q       Cost: The Regimen costs about US$ 1000

q       Intervention needs to be introduced early when most women in resource poor countries attend antenatal care late in pregnancy

The use of shorter regimens or other antiretrovirals provides an alternative

Short Course Zidovudine Treatment

ü   More feasible in resource poor countries

The Bangkok Perinatal AZT Study, 1996:

ü   Randomized placebo controlled trial

ü   All women given infant feeding formula and advised not to breast feed

Results Of The Bangkok Perinatal AZT Study

Almost 50% reduction in transmission (May 1996 - December 1997 : 393 mother child pairs analysed)

Reference:

Schaffer N et al. Short Course zidovudine for perinatal HIV - 1 transmission in Bangkok, Thailand: a randomized control trial. Lancet March 1999, 353 : 773 - 80

The Cote d'Ivoire Trial:

ü   Randomized placebo controlled trial

ü   Over 95% of the infants were breast fed

Results Of The Cote d'Ivoire Trial

Almost 36% reduction in transmission (119 mother child groups analysed)

Reference:

Dasbis F et al for the DITRAME Study Group 6 month efficacy, tolerance and acceptability of a short course regimen of zidovudine to reduce vertical transmission of HIV in breastfed children in Cote d'Ivoire : a double blind placebo control multicentric trial. Lancet, 1999, 353 : 786-92

Combination Therapy

The UNAIDS co-ordinated PETRA trial using Zidovudine + Lamivudine

ü   Study still in progress but interim results at 6 weeks of age infants available

ü   Compares 3 different regimes versus a placebo in Breastfeeding Population

Drugs: Zidovudine + Lamivudine

Results Of The UNAIDS co-ordinated PETRA trial

(1790 mother child groups analysed)

Others - Nevirapine: Efficacy studies have commenced on Neirapine (NNRTI) as the drug achieves high circulating levels which are long lasting  raising the possibility of a one dose treatment in labour : Results Awaited

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