Article type
Year
Abstract
Objectives: To assess the efficacy of different regimens of peripartum antiretroviral therapies (ART) for preventing mother-to-child transmission (MTCT), and to identify risk factors for MTCT of HIV.
Methods: We searched PubMed, EMBASE, CINAHL, AID Search, AIDS LINE, AIDSTRIALS, AIDSDRUGS, AIDS info and the Chinese Databases (CBM, CNKI, VIP) from the beginning of the databases to April 30, 2007. The Cochrane Library (2007 issue 1) was also searched. Systematic review (SRs) or meta-analyses of randomized controlled trials (RCTs) with pooled results to assess the efficacy, side effects of ART for preventing MTCT and risk factors of HIV were included. The selection, quality assessment and data extraction were undertaken independently by two review authors. Data were analyzed using Stata 8.0.
Results: Six systematic reviews were eligible, including 2 Cochrane reviews and 4 meta-analyses using individual patient data (IPD Meta-analysis). The quality of the included studies were relatively high with Oxman and Guyatt scores varying from 5 to 7 and QUOROM score from 12-16. In comparison with placebo, zidovudine (ZDV)-containing regimen significantly reduced the risk of MTCT of HIV (NNT=7-14, p<0.05), especially the long-course ZDV (NNT=6.68, 95%CI 4.59-12.3). Nevirapine (NVP) was more effective than ZDV in preventing the risk of MTCT of HIV (NNT 9-13, p<0.05). Only long-course combination therapy using zidovudine and lamivudine (ZDV+3TC) suggested a decrease in the risk of transmission compared with placebo (NNT=11, 95%CI 6-41) and NVP (adjusted OR=0.39, p<0.0005). The results of multivariable logistic regression analysis with placebo as the reference category showed that the risk of MTCT of HIV was significantly higher with low maternal CD4 cell count, high maternal viral load, breastfeeding, low birth weight, and the sex of babies.
Conclusion: ART is effective in preventing MTCT of HIV. In resource-limited countries the single-dose NVP and short-course ZDV are less expensive, more feasible and easier to access to long course of ZDV and ZDV+3TC. Interventions to decrease transmission of HIV-1 through breast-feeding are urgently needed.
Methods: We searched PubMed, EMBASE, CINAHL, AID Search, AIDS LINE, AIDSTRIALS, AIDSDRUGS, AIDS info and the Chinese Databases (CBM, CNKI, VIP) from the beginning of the databases to April 30, 2007. The Cochrane Library (2007 issue 1) was also searched. Systematic review (SRs) or meta-analyses of randomized controlled trials (RCTs) with pooled results to assess the efficacy, side effects of ART for preventing MTCT and risk factors of HIV were included. The selection, quality assessment and data extraction were undertaken independently by two review authors. Data were analyzed using Stata 8.0.
Results: Six systematic reviews were eligible, including 2 Cochrane reviews and 4 meta-analyses using individual patient data (IPD Meta-analysis). The quality of the included studies were relatively high with Oxman and Guyatt scores varying from 5 to 7 and QUOROM score from 12-16. In comparison with placebo, zidovudine (ZDV)-containing regimen significantly reduced the risk of MTCT of HIV (NNT=7-14, p<0.05), especially the long-course ZDV (NNT=6.68, 95%CI 4.59-12.3). Nevirapine (NVP) was more effective than ZDV in preventing the risk of MTCT of HIV (NNT 9-13, p<0.05). Only long-course combination therapy using zidovudine and lamivudine (ZDV+3TC) suggested a decrease in the risk of transmission compared with placebo (NNT=11, 95%CI 6-41) and NVP (adjusted OR=0.39, p<0.0005). The results of multivariable logistic regression analysis with placebo as the reference category showed that the risk of MTCT of HIV was significantly higher with low maternal CD4 cell count, high maternal viral load, breastfeeding, low birth weight, and the sex of babies.
Conclusion: ART is effective in preventing MTCT of HIV. In resource-limited countries the single-dose NVP and short-course ZDV are less expensive, more feasible and easier to access to long course of ZDV and ZDV+3TC. Interventions to decrease transmission of HIV-1 through breast-feeding are urgently needed.