Vaginal disinfection during labour to reduce mother-to-child transmission of HIV

The review evaluates the effects of vaginal lavage during labour and delivery on the risk of mother-to-child transmission of HIV. Only one methodologically weak controlled trial comparing vaginal disinfection with diluted chlorhexidine (0.2%) during labour and delivery was included, based on the Cochrane selection criteria.

The results of this trial involving 606 HIV-infected women in Mombassa, Kenya, found no difference in the incidence rates of mother-to-child-transmission (MTCT) between the lavage and non-lavage group (17.2% versus 15.9%) (1).

The reviewers excluded from the review a chlorhexidine trial from Malawi because of methodological problems (large time blocks of 2-3 months) and high loss-to-follow up rates. The results of the Malawi trial also failed to show any impact on vertical transmission, except in a subgroup of women with rupture of membranes for more than 4 hours (2).

The Cochrane review does not include the results of a placebo-controlled West-African trial. One per cent benzalkonium chloride vaginal suppositories on a daily basis from 36 weeks of pregnancy, including during labour and delivery, were compared with placebo. No difference in mother-to-child transmission rates was found between the active treatment arm and the placebo group (23.5% versus 24.8%, respectively) (3).

The reviewers point out that the evidence from existing trials does not allow any conclusions on the effect of vaginal lavage in perinatal HIV infection.

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