RHL Commentary by James McIntyre
EVIDENCE SUMMARY
The review considered antiretroviral interventions to reduce the risk of mother-to-child transmission of HIV-1 (MTCT). Five trials of zidovudine as "long course therapy" or "short course therapy" (1,2,3,4,5), one trial of intrapartum and postpartum nevirapine compared to intrapartum and postpartum zidovudine (6), one trial of intrapartum nevirapine added to baseline antiretroviral treatment (7) and one trial comparing short course zidovudine + lamivudine to intrapartum and intrapartum + one week mother and child treatment (8).
The review concludes that zidovudine therapy in pregnancy (as long or short course), provides a significant reduction in the risk of MTCT and appears to reduce the risk of death within the first year of birth. The “short-short" course of zidovudine (from 35 weeks of pregnancy to 3 days after birth for the baby) was less effective than longer courses, but no difference in effectiveness was shown between the so-called “long-long”(from 28 weeks and for 6 weeks to the baby, the “short-long” (from 35 weeks and for 6 weeks to the baby) and the “long short” (from 28 weeks and for 3 days to the baby).
Nevirapine, given as one dose in labour to the mother and one dose within 72 hours of birth to the child is effective in reducing the risk of transmission, but the addition of single dose nevirapine to standard antiretroviral treatment did not show any advantage. Preliminary results from the PETRA study showed decreased transmission with a combination of zidovudine and 3TC when given before birth, or during labour, and for one week to mother and child. However, at eighteen months this effect had been lost, due to the increased transmission through breastfeeding (8).
The reviewers point out that in developed countries, treatment of the mother which includes triple drug treatment has become the standard of care and that this has further reduced the reported MTCT rates.
The review includes randomized trials comparing any antiretroviral therapy aimed at decreasing mother-to-child transmission of HIV compared with placebo or any two or more antiretroviral therapies or regimens. Eight trials met the inclusion criteria.
The full RHL commentary also includes sections on: Relevance
- Magnitude of the problem
- Feasibility of the intervention
- Applicability of the results of the Cochrane Review
- Implementation of the intervention
- Research
References
This document should be cited as: James McIntyre. Antiretroviral therapy for reducing the risk of mother-to-child transmission: RHL commentary (last revised: 1 November 2002). The WHO Reproductive Health Library, No 9, Update Software Ltd, Oxford, 2006. www.rhlibrary.com
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