Actions
  • shareshare
  • link
  • cite
  • add
add
auto_awesome_motion View all 5 versions
Publication . Article . Other literature type . 2012

Three Postpartum Antiretroviral Regimens to Prevent Intrapartum HIV Infection

Nielsen-Saines, Karin; Watts, Heather; Veloso, Valdilea G.; Bryson, Yvonne J.; Joao, Esau C.; Pilotto, Jose Henrique; Gray, Glenda; +21 Authors
Open Access  
Published: 21 Jun 2012 Journal: New England Journal of Medicine, volume 366, pages 2,368-2,379 (issn: 0028-4793, eissn: 1533-4406, Copyright policy )
Publisher: Massachusetts Medical Society
Country: Brazil
Abstract
Submitted by Anderson Silva (avargas@icict.fiocruz.br) on 2013-03-18T17:33:06Z No. of bitstreams: 1 Three Postpartum Antiretroviral Regimens.pdf: 294824 bytes, checksum: 90af1d7b9e587f1ac38e86d95ee5ee38 (MD5) Rejected by Éder Freyre(ederfreyre@icict.fiocruz.br), reason: Só coloque o ANO conforme manual. on 2013-03-18T17:51:50Z (GMT) Submitted by Anderson Silva (avargas@icict.fiocruz.br) on 2013-03-20T17:24:12Z No. of bitstreams: 1 Three Postpartum Antiretroviral Regimens.pdf: 294824 bytes, checksum: 90af1d7b9e587f1ac38e86d95ee5ee38 (MD5) Approved for entry into archive by Éder Freyre(ederfreyre@icict.fiocruz.br) on 2013-03-20T19:28:46Z (GMT) No. of bitstreams: 1 Three Postpartum Antiretroviral Regimens.pdf: 294824 bytes, checksum: 90af1d7b9e587f1ac38e86d95ee5ee38 (MD5) Submitted by Anderson Silva (avargas@icict.fiocruz.br) on 2013-03-25T17:16:20Z No. of bitstreams: 1 Three Postpartum Antiretroviral Regimens.pdf: 294824 bytes, checksum: 90af1d7b9e587f1ac38e86d95ee5ee38 (MD5) Submitted by Anderson Silva (avargas@icict.fiocruz.br) on 2013-03-25T17:29:49Z No. of bitstreams: 1 Three Postpartum Antiretroviral Regimens.pdf: 294824 bytes, checksum: 90af1d7b9e587f1ac38e86d95ee5ee38 (MD5) Approved for entry into archive by Éder Freyre(ederfreyre@icict.fiocruz.br) on 2013-03-25T17:31:35Z (GMT) No. of bitstreams: 1 Three Postpartum Antiretroviral Regimens.pdf: 294824 bytes, checksum: 90af1d7b9e587f1ac38e86d95ee5ee38 (MD5) Made available in DSpace on 2013-03-27T13:23:08Z (GMT). No. of bitstreams: 1 Three Postpartum Antiretroviral Regimens.pdf: 294824 bytes, checksum: 90af1d7b9e587f1ac38e86d95ee5ee38 (MD5) Previous issue date: 2012 The Eunice Kennedy Shriver National Institute of Child Health and Human Development [NICHD] and others University of California Los Angeles David Geffen School of Medicine, CA, Estados Unidos Eunice Kennedy Shriver National Institute Of Child Health And Human Development. Maryland, MD, Estados Unidos Fundação Oswaldo Cruz. Instituto de Pesquisa Clinica Evandro Chagas. Centro de Pesquisa Clínica Em Hiv Aids.Riod e Janeiro, RJ, Brasil University of California Los Angeles David Geffen School of Med icine, CA, Estados Unidos Hospital dos Servidores do Estado, Rio de Janeiro, RJ, Brasil Hospital Geral de Nova Iguaçu, Rio de Janeiro, RJ, Brasil University of Witwatersrand. Perinatal HIV Research Unit. , South Africa Faculty of Medicine. Department of Obstetrics and Gynecology.Tygerberg, South Africa Grupo Hospitalar Conceição. Hospital Nossa Senhora da Conceição. Departamento de Doenças Infecciosas. Porto Alegre, RS, Brasil Hospital Fêmina. Porto Alegre, RS, Brasil Irmandade da Santa Casa de Misericordia de Porto Alegre. Porto Alegre, RS, Brasil Universidade Federal de Minas Gerais. Faculdade de Medicina. Departamento de Pediatria. Minas Gerais, MG, Brasil Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Departamento de Puericultura e Pediatria. Ribeirão Preto, SP, Brasil Foundation for Maternal and Infant Health, Buenos Aires, BS, Argentina Universidade Federal de Sao Paulo. Sao Paulo, SP, Brasil The Children's Hospital of Philadelphia Research Institute. Pensilvania, PA, Estados Unidos Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Departamento de Imunologia. Rio de Janeiro, RJ, Brasil University of California Davis, California, CA, Estados Unidos National Institute of Child Health and Human Development . Maryland, MD, Estados Unidos Boston University School of Medicine. Massachusetts, MA, Estados Unidos Eunice Kennedy Shriver National Institute Of Child Health And Human Development. Maryland, MD, Estados Unidos University of Witwatersrand and Chris Hani Baragwanath Hospital.Johannesburgo, JNB, Africa do Sul Fundação Oswaldo Cruz.Instituto de Comunicação e Informação Cientifica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brasil Fundação Oswaldo Cruz.Instituto de Comunicação e Informação Cientifica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brasil Eunice Kennedy Shriver National Institute Of Child Health And Human Development. Maryland, MD, Estados Unidos Eunice Kennedy Shriver National Institute Of Child Health And Human Development. Maryland, MD, Estados Unidos Eunice Kennedy Shriver National Institute Of Child Health And Human Development. Maryland, MD, Estados Unidos Background The safety and efficacy of adding antiretroviral drugs to standard zidovudine prophylaxis in infants of mothers with human immunodeficiency virus (HIV) infection who did not receive antenatal antiretroviral therapy (ART) because of late identification are unclear. We evaluated three ART regimens in such infants. Methods Within 48 hours after their birth, we randomly assigned formula-fed infants born to women with a peripartum diagnosis of HIV type 1 (HIV-1) infection to one of three regimens: zidovudine for 6 weeks (zidovudine-alone group), zidovudine for 6 weeks plus three doses of nevirapine during the first 8 days of life (two-drug group), or zidovudine for 6 weeks plus nelfinavir and lamivudine for 2 weeks (three-drug group). The primary outcome was HIV-1 infection at 3 months in infants uninfected at birth. Results A total of 1684 infants were enrolled in the Americas and South Africa (566 in the zidovudine-alone group, 562 in the two-drug group, and 556 in the three-drug group). The overall rate of in utero transmission of HIV-1 on the basis of Kaplan–Meier estimates was 5.7% (93 infants), with no significant differences among the groups. Intrapartum transmission occurred in 24 infants in the zidovudine-alone group (4.8%; 95% confidence interval [CI], 3.2 to 7.1), as compared with 11 infants in the two-drug group (2.2%; 95% CI, 1.2 to 3.9; P = 0.046) and 12 in the three-drug group (2.4%; 95% CI, 1.4 to 4.3; P = 0.046). The overall transmission rate was 8.5% (140 infants), with an increased rate in the zidovudine-alone group (P = 0.03 for the comparisons with the two- and three-drug groups). On multivariate analysis, zidovudine monotherapy, a higher maternal viral load, and maternal use of illegal substances were significantly associated with transmission. The rate of neutropenia was significantly increased in the three-drug group (P<0.001 for both comparisons with the other groups). Conclusions In neonates whose mothers did not receive ART during pregnancy, prophylaxis with a two- or three-drug ART regimen is superior to zidovudine alone for the prevention of intrapartum HIV transmission; the two-drug regimen has less toxicity than the threedrug regimen.
Subjects by Vocabulary

Microsoft Academic Graph classification: Lamivudine medicine.drug medicine Immunology Obstetrics medicine.medical_specialty Global health business.industry business Nevirapine Nelfinavir Pregnancy medicine.disease Zidovudine Preventive healthcare Postpartum period Human immunodeficiency virus (HIV) medicine.disease_cause

Subjects

General Medicine, Kaplan-Meier Estimate, Antiretroviral Therapy, Highly Active /utilization, Zidovudine /therapeutic use, Prenatal Diagnosis /utilization, HIV-1 /pathogenicity, Nevirapine /therapeutic use, HIV Antigens /therapeutic use, Americas /epidemiology, Africa /epidemiology, Estimativa de Kaplan-Meier, Terapia Antirretroviral de Alta Atividade /utilização, Zidovudina /uso terapêutico, Diagnóstico Pré-Natal /utilização, HIV-1 /patogenicidade, Nevirapina /uso terapêutico, Antígenos HIV /uso terapêutico, Américas /epidemiologia, África /epidemiologia, Article, Obstetrics and Gynecology