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Efficacy of an Ultra Short Zidovudine (ZDV)regimen in the prevention of Perinatal HIV Transmission in Zimbabwe
P. THISTLE1, G. ARBESS2, R. DAYAN2, I. CHITSIKIE1, R. GLAZIER2, R. PILON3, S. CASSOL3, CHIPATO I1, J. EMBREE4, MICHAEL S. SILVERMAN2;
1University of Zimbabwe, Harare, Zimbabwe, 2University of Toronto, Toronto, Canada, 3University of Ottawa, Ottawa, Canada, 4University of Manitoba, Winnipeg, Canada.
Presentation Number: 232
BACKGROUND A 4 week course of ZDV was demonstrated to decrease Perinatal transmission by 51% in Thailand. This regimen became the WHO recommendation for resource poor countries. Due to cost, even this abbreviated regimen is not available in most of Africa. Longer courses are likely more effective, but also more expensive. As in many countries, Nevaripine is not yet licensed for routine use in Zimbabwe. Retrospective studies suggest that the most important portion of the ZDV prevention protocol is that given to the neonate, in the first 48 hours. METHOD Between Nov 1999 and Dec 2000, 223 patients were enrolled in a prospective randomized double-blind trial in a rural hospital in Zimbabwe. After informed consent, HIV seropositive expectant mothers were randomized at 36 weeks to A (THAI Protocol): ZDV 300mg PO BID to start at 36 weeks and continue until labour onset, then 300mg PO Q3H until delivery, with no active drug given to the neonate; or B (ultra short): No active drug until the onset of labour, then ZDV 300mg PO Q3H while in labour, and ZDV 2mg/kg Q6H PO to the neonate for 72 hours postpartum. Appropriate placebo was added to each regimen to maintain blinding. Sequential infant heel prick blood samples were collected on filter blot paper and assessed for HIV-1 viral RNA by the Nuclisens QL assay. Counselling regarding breast-feeding was carried out as per Zimbabwe national guidelines.RESULTS Preliminary Results
Infant PCR
AB
TimeInfectedTotal%InfectedTotal%
Birth5697.26748.1
2 week105916.9106415.6
6 week145525.5146222.5
3 month175034.0165429.6

DISCUSSION Regimen B is less expensive (4$ vs110$US), easier to administer and due to its brevity, is less likely to induce drug resistance and helps maintain patient confidentiality. The equivalent efficacy therefore makes regimen B preferable to A.
 
 
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