Maternal anaemia and duration of zidovudine in antiretroviral regimens for preventing mother-to-child transmission: a randomized trial in three African countries

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Sartorius, Benn, K.D. | Chersich, Matthew, F. | Mwaura, Mary | Meda, Nicolas | Temmerman, Marleen | Newell, Marie-Louise | Farley, Tim | Luchters, Stanley | Rollins, Nigel | Reyners, Marcel | Nduati, Ruth | Fao, Paulin | Ky-Zerbo, Odette | Gouem, Clarisse | Mcfetridge, Lynne | Naidu, Kevi | Irungu, Eunice | Kose, Judith | Mepham, Stephen | de Vincenzi, Isabelle | Somda, Paulin | Hien, Hervé | Elysée Ouedraogo, Patrice | Kania, Dramane | Sanou, Armande | Ayassou Kossiwavi, Ida | Sanogo, Bintou | Ouedraogo, Moussa | Siribie, Issa | Katingima, Christine | Ouattara, Gina | Bland, Ruth, M. | Taylor, Allan | Flowers, Nicole | Thigpen, Michael | Fowler, Mary, Glenn | Jamieson, Denise | Read, Jennifer S. | Valéa, Diane | Mandaliya, Kishor | Wambua, Sammy | Njagi, Ephantus | Viljoen, Johannes | van de Perre, Philippe | Becquart, Pierre | Foulongne, Vincent | Segondy, Michel | Ouedraogo, Sayouba | Somé, Roseline | Thiongo, Mary | Mwaura, Peter | Rouet, François | Gaillard, Philippe | Bork, Kirsten, A | Cames, Cecile | Cournil, Amandine | Habib, Ndema | Landoulsi, Sihem | Bazin, Brigitte | Rekacewicz, Claire | Mofenson, Lynne | Claeys, Patricia

Edité par CCSD ; BioMed Central -

International audience. Background: Although substantiated by little evidence, concerns about zidovudine-related anaemia in pregnancy have influenced antiretroviral (ARV) regimen choice for preventing mother-to-child transmission of HIV-1, especially in settings where anaemia is common.Methods: Eligible HIV-infected pregnant women in Burkina Faso, Kenya and South Africa were followed from 28 weeks of pregnancy until 12–24 months after delivery (n = 1070). Women with a CD4 count of 200-500cells/mm3 and gestational age 28–36 weeks were randomly assigned to zidovudine-containing triple-ARV prophylaxis continued during breastfeeding up to 6-months, or to zidovudine during pregnancy plus single-dose nevirapine (sd-NVP) at labour. Additionally, two cohorts were established, women with CD4 counts: <200 cells/mm3 initiated antiretroviral therapy, and >500 cells/mm3 received zidovudine during pregnancy plus sd-NVP at labour. Mild (haemoglobin 8.0-10.9 g/dl) and severe anaemia (haemoglobin < 8.0 g/dl) occurrence were assessed across study arms, using Kaplan-Meier and multivariable Cox proportional hazards models.Results: At enrolment (corresponded to a median 32 weeks gestation), median haemoglobin was 10.3 g/dl (IQR = 9.2-11.1). Severe anaemia occurred subsequently in 194 (18.1%) women, mostly in those with low baseline haemoglobin, lowest socio-economic category, advanced HIV disease, prolonged breastfeeding (≥6 months) and shorter ARV exposure. Severe anaemia incidence was similar in the randomized arms (equivalence P-value = 0.32). After 1–2 months of ARV’s, severe anaemia was significantly reduced in all groups, though remained highest in the low CD4 cohort.Conclusions: Severe anaemia occurs at a similar rate in women receiving longer triple zidovudine-containing regimens or shorter prophylaxis. Pregnant women with pre-existing anaemia and advanced HIV disease require close monitoring.

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