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Session 135 Poster Abstracts
Prevention of Mother-to-Child Transmission
Thursday, 1:30 - 3:30 pm
Hall B


782    
Efficacy of Peripartum Nevirapine to Prevent Mother to Child HIV Transmission in Women Presenting Late for Antenatal Care in Thailand
Gonzague Jourdain*1, S Le Coeur2, N Ngo-Giang-Huong1, W Karnchanamayul3, S Ariyadej3, K Kovitanggoon4, S Tonmat4, C Ngampiyasakul5, P Yuthavisuthi5, M Lallemant6, and Perinatal HIV Prevention Trial Group (PHPT), Thailand
1Harvard Sch of Publ Hlth, Chiang Mai, Thailand; 2Inst Natl d'Etudes Demographiques, Paris, France; 3Provincial Hosp, Rayong, Thailand; 4Provincial Hosp, Mahasarakam, Thailand; 5Prapokklao Hosp, Chantaburi, Thailand; and 6Insti de Recherche pour le Dévt, UR 054, Chiang Mai, Thailand

Background:  Given the efficacy of ART in preventing mother-to-child transmission of HIV (MTCT), an increasing proportion of pediatric HIV infections are the result of situations where pregnant women receive minimal or no antenatal care. Interventions specifically targeting these women are being evaluated.

Methods:  In the context of a large perinatal HIV prevention trial in Thailand, women who could not enroll because they presented too late during pregnancy were offered open-label antiretroviral prophylaxis and followed separately. In addition to zidovudine (ZDV) for the remaining part of pregnancy, women were offered a single dose nevirapine (NVP) during labor, and their infants 4 weeks ZDV and a single-dose NVP 48 to 72 hours after birth. Infants HIV status was assessed using the HIV DNA PCR Roche 1.5 test kit. Kaplan Meier transmission rates and 95% confidence intervals (CI) were estimated (Stata 8.0).

Results:  Emergency antiretroviral prophylaxis was offered to 137 HIV+ women. Baseline characteristics of mothers were:  median age 26 years; weight 59 kg, hemoglobin level 11.1 g/100 mL, CD4 count 411 cell/mm3, and gestational age at delivery 38.1 weeks; 41 delivered by caesarean sections; 138 children were born, including 2 sets of twins. The median birth weight was 2.8 kg (24% equal or below 2.5 kg); 98% of the children had at least one PCR test and the HIV status was confirmed in 115 infants (84%); 90 women (66%) did not receive any ZDV before labor and the other received < 15 days of ZDV; 82% received a ZDV loading dose; 95% of the newborn were prescribed 6 weeks of ZDV but 5% received ZDV for 1 week. Transmission rates were 15.7% (CI 9.7 to 25%) among the 103 cases where NVP was administered to the mother and the newborn, 23.2% (CI 11.1 to 45%) in 29 cases where only to the newborn received NVP. There were no transmissions in the 3 cases where only the mother received NVP, and in the 2 cases where neither the mother nor the infant received NVP.

Conclusions:  Compared with the results of PHPT-2, where women received ZDV at 28 weeks or as soon as possible thereafter, the efficacy of peripartum NV P following no or < 2 weeks of ZDV prophylaxis was very poor. This emphasizes the need for ART prophylaxis during the whole third trimester of pregnancy and therefore medico-social interventions targeting these women.

 

Keywords: mother-to-child; transmission; nevirapine