1921
Volume 69, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

To determine the feasibility of using short-course zidovudine (ZDV) to prevent mother-to-child transmission of human immunodeficiency virus (HIV) in a breastfeeding population in a rural area in Kenya, pregnant mothers attending clinics in seven health centers in western Kenya between 1996 and 1998 were requested to volunteer for participation in this study. The HIV-infected mothers were given a daily dose of 400 mg of ZDV starting at 36 weeks of gestation and another 300 mg every three hours intrapartum. After delivery, mothers and their children were followed-up and clinically monitored every 3–4 months for two years, and child and mother mortality rates were analyzed. Of the 825 mothers who consented, 216 (26.2%) were infected with HIV. Of those infected, 51 (23.6%) took the full prescribed dose, 69 (31.9%) took only the prenatal dose, and the remaining 96 (44.4%) did not take any dose. Failure to take ZDV was attributed mainly to delivery occurring earlier than expected, while non-compliance to the intrapartum dose was due to mothers giving birth at home and fear of traditional birth attendants. By the end of the second year, 75 HIV-exposed children (34.7%) and 33 HIV-infected mothers (15.3%) had died. The HIV-free survival of children at 24 months was significantly associated with mother survival ( < 0.001) and prenatal ZDV compliance ( < 0.003). Our findings suggest that implementation of programs for prevention of mother-to-child transmission of HIV in rural areas of Africa need to consider the various socioeconomic and cultural barriers that may prevent successful uptake of antiretroviral prophylaxes. Similarly, the rapid disease progression in mothers may eliminate the increase in child survival due to ZDV prophylaxis.

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2003-07-01
2017-09-24
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References

  1. Connor EM, Sperling RS, Gelbert R. Kiselev P, Scott G, O’Sullivan MJ, van Dyke R, Bey M. Shearer W. Jacobson RL, Jimenez E, O’Neill E, Bazin B, Delfraissy JF, Culnane M, Coombs R, Elkins M, Moye J, Stratton P, Balsley J, 1994. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. N Engl J Med 3312 : 1173–1180.
  2. Centers for Disease Control, 1994. Recommendations of the U.S.Public Health Service Task Force on the use of zidovudine to reduce perinatal transmission of human immunodeficiency virus. MMWR Morb Mortal Wkly Rep 43 : 1–20.
  3. Shaffer N, Chuachoowong R, Mock PA, Bhadrakom C, Siriwasin W, Young NC, Chotpitayasunondh T, Chearskul S, Roongpisuthipong A, Chinayon P, Karon J, Mastro TM, Simonds RJ, 1999. Short course oral zidovudine for perinatal HIV-1 transmission in Bangkok, Thailand: a randomized controlled trial. Lancet 353 : 773–780.
  4. Wiktor SZ, Ekpini E, Karon JM, Nkengasong J, Maurice C, Severin ST, Roels TH, Kouassi MK, Lackritz EM, Coulibaly IM, Greenberg AE, 1999. Short course oral zidovudine for prevention of mother-to-child transmission of HIV-1 in Abidjan, Côte d’Ivoire: a randomized trial. Lancet 353 : 781–785.
  5. Dabis F, Msellati P, Meda N, Weffens-Ekra C, You B, Manigart O, Leroy V, Simonon A., Cartoux M, Combe P, Ouangre A, Ramon R, Ky-Zerbo O, Montcho C, Salamon R, Rouzioux C, van de Perre P, Mandelbrot L, 1999. Six-month efficacy, tolerance and acceptability of short regimen of oral zidovudine to reduce vertical transmission of HIV in breastfeed children in Côte d’Ivoire and Burkina Faso: a double blind placebo-controlled multicentre trial. Lancet 353 : 786–792.
  6. The Petra Study Team, 2002. Efficacy of three short-course regimens of zidovudine and lamivudine in preventing early and late transmission of HIV-1 from mother to child in Tanzania, South Africa, and Uganda (Petra study): a randomized, double-blind, placebo-controlled trial. Lancet 359 : 1178–1186.
  7. Guay LA, Musoke P, Fleming T, Bagenda D, Allen M, Nakabiito C, Sherman J, Bakaki P, Ducar C, Deseyve M, Emel L, Mirochnick M, Fowler MG, Mofenson L, Miotti P, Dransfield K, Bray D, Mmiro F, Jackson JB, 1999. Intrapartum and neonatal single dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomized trial. Lancet 354 : 795–802.
  8. World Health Organization, 2000. New data on the prevention of mother-to-child transmission of HIV and their policy implications: conclusions and recommendations. Geneva: World Health Organization. http://www.who.int/reproductive-health/RTIs.
  9. Fowler MG, 2000. Prevention of perinatal infection. What do we know? Where should future research go? Ann NY Acad Sci 918 : 45–52.
  10. De Cock KM, Fowler MG, Mercier E, Vicenzi I, Saba J, Hoff E, Alnwick DJ, Rogers M, Shaffer N, 2000. Prevention of mother-to-child transmission of HIV in resource poor countries: translating research into policy and practice. JAMA 283 : 1175–1182.
  11. Songok EM, Kakimoto K, Genga I, Okello C, Makokha E, Kageyama S, Kobayashi N, Fujiyama Y, Ichimura H, 2001. Prenatal short course zidovudine reduces mortality in children born to human immunodeficiency virus-positive mothers in rural Kenya. J Infect Dis 183 : 1540–1541.
  12. Beckerman KP, 2002. Mothers, orphans and prevention of pediatric AIDS. Lancet 359 : 1168–1169.
  13. Hankins C, 2000. Preventing mother to child transmission of HIV in developing countries: recent developments and ethical implications. Reprod Health Matters 15 : 87–92.
  14. Ayisi JG, van Eijk AM, ter Kuile FO, Kolczak MS, Otieno JA, Misore AO, Kager PA, Steketee RW, Nahlen BL, 2000. Risk factors for HIV infection among asymptomatic pregnant women attending an antenatal clinic in western Kenya. Int J STD AIDS 11 : 393–401.
  15. Buve A, Carael M, Hayes J, Auvert B, Ferry B, Robinson NJ, Anagonou S, Kanhonou L, Laoruou M, Abega S, Ekam E, Zekeng L, Chege J, Kahindo M, Rutenberg N, Kaona F, Musonda R, Sukwa T, Morison L, Weiss HA, Laga M, 2001. Multicentre study on factors determining differences in rate of spread of HIV in Sub-Saharan Africa: methods and prevalence of HIV infection. AIDS 15 (Suppl): S5–S14.
  16. Chimbira TH, 1989. Uncertain gestation and pregnancy outcome. Cent Afr J Med 35 : 329–333.
  17. Taipale P, Hiilesmaa V, 2001. Predicting delivery date by ultrasound and last menstrual period in early gestation. Obstet Gynecol 97 : 189–194.
  18. Bulterys M, Glen Fowler MG, Shaffer N, Tih MP, Greenberg AE, Karita E, Coovadia H, De Cock KM, 2002. Role of traditional birth attendants in preventing perinatal transmission of HIV. BMJ 324 : 222–225.
  19. Dabis F, Ekpini ER, 2002. HIV-1/AIDS and maternal and child health in Africa. Lancet 359 : 2097–2104.
  20. Walvaren G, Weeks A, 1999. The role of traditional birth attendants with midwifery skills in the reduction of maternal mortality. Trop Med Int Health 4 : 527–529.
  21. Rabie H, Pieper CH, Robson B, Cotton MF, 2001. Postnatal zidovudine in prevention of vertical HIV-1 transmission in a service setting. J Trop Pediatr 4 : 215–219.
  22. Dabis F, Elenga N, Meda N, Leroy V, Viho I, Manigart O, Dequae-Merchadou L, Msellati P, Sombie I, 2001. 18-Month mortality and perinatal exposure to zidovudine in West Africa. AIDS 15 : 771–779.
  23. Miotti PG, Taha TET, Kumwenda NI, Broadhead R, Mtimavalye LA, van der Hoeven L, Chipangwi JD, Liomba G, Biggar RJ, 1999. HIV transmission through breastfeeding-a study in Malawi. JAMA 282 : 744–749.
  24. Leroy V, Karon JM, Alioum A,Ekpini ER, Meda N, Greenberg AE, Msellati P, Hudgens M, Dabis F, Wiktor SZ, 2002. Twenty-four month efficacy of a maternal short course zidovudine regimen to prevent mother-to-child transmission of HIV-1 in west Africa. AIDS 16 : 631–641.
  25. Nduati R, John G, Mbori-Ngacha D, Richardson B, Overbaugh J, Mwatha A, Ndinya-Achola J, Bwayo J, Onyango FE, Hughes J, Kreiss J, 2000. Effect of breastfeeding and formula feeding on transmission of HIV-1: a randomized clinical trial. JAMA 282 : 1167–1174.
  26. Nduati R, Richardson BA, Grace J, Mbori-Ngacha D, Mwatha A, Ndinya-Achola J, Bwayo J, Onyango F, Kreiss J, 2001. Effect of breastfeeding on mortality among HIV-1 infected women: a randomized trial. Lancet 357 : 1651–1655.
  27. Morgan D, Mahe C, Mayanja B, Whitworth JA, 2002. Progression to symptomatic disease in people infected with HIV-1 in rural Uganda: prospective cohort study. BMJ 324 : 193–197.
  28. Lambert G, Thea DM, Pliner V, Steketee RW, Abrams EJ, Matheson P, Thomas PA, Greenberg B, Brown TM, Banji M, Kalish ML, 1997. Effect of maternal CD4+ cell count, acquired immune deficiency syndrome and viral load on disease progression in infants with perinatally acquired human immunodeficiency virus type 1 infection. J Pediatr 130 : 830–837.
  29. McElroy PD, ter Kuile FO, Hightower AW, Hawley AW, Phillips-Howard AP, Oloo AJ, Lal AA, Nahlen BL, 2001. All cause mortality among children in western Kenya. VI. The Asembo Bay cohort project. Am J Trop Med Hyg 64 : 18–27.
  30. Bloland PB, Boriga DA, Ruebush TK, McCormick JB, Roberts JM, Oloo AJ, Hawley W, Lal A, Nahlen B, Campbell CC, 1999. Longitudinal cohort study of the epidemiology of malaria infections in an area of intense malaria transmission. II. Descriptive epidemiology of malaria infection and disease among children. Am J Trop Med Hyg 60 : 641–648.
  31. Bloland PB, Wirima JJ, Steketee RW, Chilima B, Hightower A, Breman JG, 1995. Maternal HIV infection and infant mortality in Malawi: evidence for increased mortality due to placental malaria infection. AIDS 9 : 721–726.
  32. Hoffman IF, Jere CS, Taylor TE, Munthali P, Dyer JR, Wirima JJ, Rogerson SJ, Kumwenda N, Eron JJ, Fiscuss SA, Chakraborty H, Taha TE, Cohens MS, Molyneux ME, 1999. The effect of Plasmodium falciparum malaria on HIV-1 RNA blood plasma concentrations. AIDS 13 : 487–494.
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  • Received : 14 Oct 2002
  • Accepted : 12 Feb 2003

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