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Use of combination neonatal prophylaxis for the prevention of mother-to-child transmission of HIV infection in European high-risk infants.
MedLine Citation:
PMID:  23211776     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES:: To evaluate use of combination neonatal prophylaxis (CNP) in infants at high risk of mother-to-child transmission (MTCT) of HIV in Europe and investigate whether CNP is more effective in preventing MTCT than single drug neonatal prophylaxis (SNP). DESIGN:: Individual patient-data meta-analysis across 8 observational studies. METHODS:: Factors associated with CNP receipt and with MTCT were explored by logistic regression using data from non-breastfed infants, born 1996-2010 and at high risk of MTCT. RESULTS:: In 5285 mother-infant pairs, 1463 (27.7%) had no antenatal or intrapartum antiretroviral prophylaxis, 915 (17.3%) had only intrapartum prophylaxis and 2907 (55.0%) mothers had detectable delivery viral load (VL) despite receiving antenatal ART. Any NP was administered to 4623 (87.5%) infants altogether; 1105 (23.9%) received CNP. Factors significantly associated with receipt of CNP were later calendar birth year, no elective caesarean section, maternal CD4 count < 200/μL, maternal delivery VL >1000 copies/mL, no antenatal ART, receipt of intrapartum single-dose nevirapine and cohort. After adjustment, absence of NP was associated with higher risk of MTCT compared to NP (aOR:2.29; 95%CI:1.46-2.59; P < 0.0001). Further, there was no association between CNP and MTCT compared to SNP (aOR 1.41; 95%CI:0.97-2.5;P=0.07). CONCLUSIONS:: In this European population, CNP use is increasing and associated with presence of MTCT risk factors. The finding of no observed difference in MTCT risk between one drug and CNP may reflect residual confounding or the fact that CNP may be effective only in a subgroup of infants rather than the whole population of high-risk infants.
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-3
Journal Detail:
Title:  AIDS (London, England)     Volume:  -     ISSN:  1473-5571     ISO Abbreviation:  AIDS     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8710219     Medline TA:  AIDS     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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