Abstract | BACKGROUND: 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.
|
Authors | R 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 |
Journal | Lancet (London, England)
(Lancet)
Vol. 347
Issue 9016
Pg. 1647-50
(Jun 15 1996)
ISSN: 0140-6736 [Print] England |
PMID | 8642957
(Publication Type: Clinical Trial, Comparative Study, Controlled Clinical Trial, Journal Article, Research Support, U.S. Gov't, P.H.S.)
|
Chemical References |
|
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)
|