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

作者：Sartorius Benn K D; Chersich Matthew F; Mwaura Mary; Meda Nicolas; Temmerman Marleen; Newell Marie Louise; Farley Timothy M M; Luchters Stanley^*

来源：BMC Infectious Diseases, 2013, 13: 522.

DOI：10.1186/1471-2334-13-522

• Zidovudine
• Pregnancy
• HIV
• Sub-Saharan Africa
• Anaemia
• Drug toxicity

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. %26lt;br%26gt;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/mm(3) 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: %26lt;200 cells/mm(3) initiated antiretroviral therapy, and %26gt;500 cells/mm(3) received zidovudine during pregnancy plus sd-NVP at labour. Mild (haemoglobin 8.0-10.9 g/dl) and severe anaemia (haemoglobin %26lt; 8.0 g/dl) occurrence were assessed across study arms, using Kaplan-Meier and multivariable Cox proportional hazards models. %26lt;br%26gt;Results: At enrolment (corresponded to amedian 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 (%26gt;= 6 months) and shorter ARV exposure. Severe anaemia incidence was similar in the randomized arms (equivalence P-value = 0.32). After 1-2months of ARV%26apos;s, severe anaemia was significantly reduced in all groups, though remained highest in the low CD4 cohort. %26lt;br%26gt;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.

• 出版日期2013-11-6