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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Abstract
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.

 

Authors & affiliation: 
Benn KD Sartorius1,2, Matthew F Chersich1,3, Mary Mwaura4, Nicolas Meda5, Marleen Temmerman3,Marie Louise Newell6, Timothy MM Farley7, Stanley Luchters1,3,8* and for the Kesho Bora Study Group 1School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 2Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal,Mtubatuba, South Africa. 3International Centre for Reproductive Health,Department of Obstetrics and Gynaecology, Ghent University, Ghent,Belgium. 4International Centre for Reproductive Health, Mombasa, Kenya. 5Centre Muraz, Bobo Dioulasso, Burkina Faso. 6Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, KwaZulu-Natal,South Africa. 7 Sigma3 Services SARL, Nyon, Switzerland. 8Centre for International Health, Burnet Institute, 85 Commercial Road, Melbourne,Victoria 3004, Australia.
Ranking: 
Published In: 
BMC Infect Dis. 2013 Nov 6, 13:522
Publication date: 
Wednesday, November 6, 2013
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