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Perinatal intervention trial in Africa: effect of a birth canal cleansing intervention to prevent HIV transmission.

AbstractBACKGROUND:
Perinatal transmission of human immunodeficiency virus (HIV) type 1 contributes significantly to infant mortality. Exposure in the birth canal may account for some transmission. We examined the efficacy of a birth canal washing procedure in reducing perinatal transmission in Malawi.
METHODS:
The infection status of infants of 3327 control women (conventional delivery procedures) was compared with that of 3637 infants of intervention-delivered women. The infants' HIV status was determined by polymerase chain reaction on dried blood spots collected at 6 and 12 weeks of age. The intervention consisted of manual cleansing of the birth canal with a cotton pad soaked in 0.25% chlorhexidine, which was done on admission in labour and every 4 h until delivery.
FINDINGS:
No adverse reactions to the intervention procedure were seen. 2094 (30%) of the enrolled women were HIV-infected, and 59% of their infants were seen in follow-up. Among 982 vaginal vertex singleton deliveries to HIV-infected women, 269 (27%) infants were infected. The intervention had no significant impact on HIV transmission rates (27% in 505 intervention women compared with 28% in 477 control women), except when membranes were ruptured more than 4 h before delivery (transmission 25% in the intervention group vs 39% in the control group).
INTERPRETATION:
If birth canal exposure is an important risk factor, different or additional methods to reduce the risk of perinatal HIV transmission should be tested. Alternatively, perhaps birth canal exposure is not a major contributor to perinatal infection risk.
AuthorsR J Biggar, P G Miotti, T E Taha, L Mtimavalye, R Broadhead, A Justesen, F Yellin, G Liomba, W Miley, D Waters, J D Chiphangwi, J J Goedert
JournalLancet (London, England) (Lancet) Vol. 347 Issue 9016 Pg. 1647-50 (Jun 15 1996) ISSN: 0140-6736 [Print] England
PMID8642957 (Publication Type: Clinical Trial, Comparative Study, Controlled Clinical Trial, Journal Article, Research Support, U.S. Gov't, P.H.S.)
Chemical References
  • Chlorhexidine
Topics
  • Adult
  • Chlorhexidine (administration & dosage)
  • Female
  • HIV Infections (prevention & control, transmission)
  • HIV-1
  • Humans
  • Infant Mortality
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical (prevention & control)
  • Labor, Obstetric
  • Malawi
  • Polymerase Chain Reaction
  • Pregnancy
  • Vagina (drug effects, virology)

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