
| Post-Durban Update on ARVs for MTCT-prevention (UNAIDS, 2000, 8 p.) |
|
Three studies provided information on whether the short-term benefits of the different ARV regimens is maintained in infants exposed to HIV through breastfeeding (Table 3). The pooled analysis from the West African studies showed that the difference in transmission rates at 3 months was still present up to 24 months.12 Similarly for the HIVNET012 study up to 12 months follow-up.13 By contrast the PETRA study reported that the differences seen in HIV-free survival between study arms at 6 weeks had decreased by 18 months.5 However, it is unclear whether this diminution of the difference is due to increased HIV transmission or to non-HIV-related mortality. The PETRA Study team announced that further information on the exact timing of transmission through breastfeeding from their trial will be available in September 2000.
Table 3: Long term follow-up in breast feeding populations
|
Trial |
Ref |
Intervention |
Early transmission |
Late transmission | |||||||
| | | |
Age |
Rate |
Difference |
Efficacya |
Age |
Rate (%) |
Difference |
Efficacya | |
|
West African pooled analysis |
12 |
ZDV from 36 w |
3m |
16% |
9% |
35% |
24m |
22% |
8% |
28% | |
| | |
Placebo |
3m |
25% | | |
24m |
30% | | | |
|
HIVNET012 |
13 |
NVP |
6-8 w |
12% |
8% |
41% |
12m |
16% |
8% |
35% | |
| | |
ZDV Intrapartum |
6-8 w |
20% | | |
12m |
24% | | | |
|
PETRAb |
| | |
| | |
| | |
| |
|
|
Arm A |
5 |
From 36w + 1w pp |
6 w |
8% |
11% |
57% |
18m |
21% |
6% |
21% |
| |
Arm B | |
In labour + 1 w pp |
6 w |
12% |
7% |
36% |
18m |
25% |
2% |
7% |
| |
Arm C | |
In labour only |
6 w |
19% |
0% |
2% |
18m |
28% |
-1% |
-4% |
| |
Placebo | |
|
6 w |
19% | | |
18m |
27% | | |
Note
a Prevented fraction (1 - rate in active group/rate in comparison group)
b Endpoint: HIV transmission and mortality (= 1- HIV-free survival)
References (numbers according to final reference list)
12 Wiktor, Durban TuOrB354
5 Gray, Durban LbOr5
13 Owor, Durban LbOr1