Antiviral activity of nucleoside analogues during short-course monotherapy or dual therapy: its role in preventing HIV infection in infants.

Abstract

BACKGROUND:

This is the first report on the preliminary efficacy of 4 different short-course nucleoside analogue regimens (stavudine [d4T], didanosine [ddI], d4T+ddI, and zidovudine [ZDV]) for the prevention of mother-to-child transmission of HIV-1 (MTCT) in a resource-limited setting.

DESIGN:

This prospective open-label, randomized 4-arm study (May 1999 to May 2000) conducted in South Africa enrolled 373 women from 34 weeks of gestation; medication was continued through delivery and for 6 weeks to infants. MTCT rates were ascertained at birth, 6, 12, and 24 weeks of age.

RESULTS:

Mean maternal HIV-1 RNA levels decreased rapidly on treatment in all groups. At week 4, the mean decrease was 1.91 log10 copies/mL (c/mL) in the d4T+ddI group, 1.33 log10 c/mL in the ddI group, 1.12 log10 c/mL in the d4T group, and 0.76 log10 c/mL in the ZDV group. Among the 362 evaluable mother-infant pairs, 11 infants in the d4T group, 10 in the ddI group, 5 in the ZDV group, and 4 in the d4T+ddI group were infected by 24 weeks of age. Eleven infections occurred in utero. Treatment with d4T and ddI was not associated with lactic acidosis or hepatic steatosis.

CONCLUSIONS:

The abbreviated use of nucleoside analogues for the prevention of MTCT appears safe and effective.

• Authors: Glenda Gray, Avye Violari, James McIntyre, Boris Jivkov, Steven Schnittman, Laurie Reynolds, Jean-Marie Ledeine
• Journal: Journal of acquired immune deficiency syndromes (1999) (J Acquir Immune Defic Syndr) Vol. 42 Issue 2 Pg. 169-76 (Jun 2006) ISSN: 1525-4135 [Print] United States
• PMID: 16639342 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Anti-HIV Agents
• RNA, Viral
• Zidovudine
• Stavudine
• Didanosine

Topics

• Acidosis, Lactic
• Anti-HIV Agents (adverse effects, therapeutic use)
• CD4 Lymphocyte Count
• Didanosine (adverse effects, therapeutic use)
• Drug Therapy, Combination
• Fatty Liver
• Female
• HIV Infections (drug therapy, prevention & control, transmission, virology)
• Humans
• Infant, Newborn
• Infectious Disease Transmission, Vertical (prevention & control)
• Male
• Mothers
• Pregnancy
• Pregnancy Complications, Infectious (drug therapy, virology)
• Prospective Studies
• RNA, Viral (blood)
• South Africa
• Stavudine (adverse effects, therapeutic use)
• Viral Load
• Zidovudine (adverse effects, therapeutic use)