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. 2000;2002(2):CD000102.
doi: 10.1002/14651858.CD000102.

Interventions aimed at decreasing the risk of mother-to-child transmission of HIV infection

P Brocklehurst  1
Affiliations

Interventions aimed at decreasing the risk of mother-to-child transmission of HIV infection

P Brocklehurst. Cochrane Database Syst Rev. 2000.

Update in

Abstract

Background: At the end of 1998 over 33 million people were infected with the human immunodeficiency virus (HIV) and over one million children had been infected from their mothers.

Objectives: The objective of this review was to assess what interventions may be effective in decreasing the risk of mother-to-child transmission of HIV infection as well as their effect on neonatal and maternal mortality and morbidity.

Search strategy: The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched.

Selection criteria: Randomised trials comparing any intervention aimed at decreasing the risk of mother-to-child transmission of HIV infection compared with placebo or no treatment, or any two or more interventions aimed at decreasing the risk of mother-to-child transmission of HIV infection.

Data collection and analysis: Trial quality assessments and data extraction were undertaken by the reviewer.

Main results: Zidovudine Four trials comparing zidovudine with placebo involving 1585 participants were included. Compared with placebo, there was a significant reduction in the risk of mother-to-child transmission with any zidovudine (relative risk (RR) 0.54, 95% confidence interval (CI) 0.42-0.69). There is no evidence that 'long course therapy' is superior to 'short course therapy'. Nevirapine One trial compared intrapartum and postnatal nevirapine with intrapartum and postnatal zidovudine in 626 women, the majority of whom breast fed their infants. Compared with zidovudine, there was a significant reduction in the risk of mother-to-child transmission of HIV with nevirapine (RR 0.58, 95% CI 0.40-0.83). No trials are available comparing nevirapine with placebo. Caesarean section One trial comparing elective caesarean section with anticipation of vaginal delivery involving 436 participants was included. Compared with vaginal delivery, there was a significant reduction in the risk of mother-to-child transmission of HIV infection with caesarean section (RR 0.17, 95% CI 0.05-0.55). Immunoglobulin One trial comparing hyperimmune immunoglobulin plus zidovudine with non-specific immunoglobulin plus zidovudine involving 501 participants was included. The addition of hyperimmune immunoglobulin to zidovudine does not appear to have any additional effect on the risk of mother-to-child transmission (RR 0.67, 95% CI 0.29-1.55).

Reviewer's conclusions: Zidovudine, nevirapine and delivery by elective caesarean section appear to be very effective in decreasing the risk of mother-to-child transmission of HIV infection.

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Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Any zidovudine vs placebo/no treatment, Outcome 1 HIV infection status in the child.
1.2
1.2. Analysis
Comparison 1 Any zidovudine vs placebo/no treatment, Outcome 2 Stillbirth.
1.3
1.3. Analysis
Comparison 1 Any zidovudine vs placebo/no treatment, Outcome 3 Neonatal mortality.
1.4
1.4. Analysis
Comparison 1 Any zidovudine vs placebo/no treatment, Outcome 4 Deaths after neonatal period.
1.5
1.5. Analysis
Comparison 1 Any zidovudine vs placebo/no treatment, Outcome 5 Late deaths.
1.6
1.6. Analysis
Comparison 1 Any zidovudine vs placebo/no treatment, Outcome 6 Maternal deaths.
1.7
1.7. Analysis
Comparison 1 Any zidovudine vs placebo/no treatment, Outcome 7 Premature delivery.
1.8
1.8. Analysis
Comparison 1 Any zidovudine vs placebo/no treatment, Outcome 8 Low birth weight.
1.9
1.9. Analysis
Comparison 1 Any zidovudine vs placebo/no treatment, Outcome 9 Neonatal haematological toxicity.
1.10
1.10. Analysis
Comparison 1 Any zidovudine vs placebo/no treatment, Outcome 10 Maternal haematological toxicity.
2.1
2.1. Analysis
Comparison 2 Short course zidovudine versus placebo/no treatment (all trials), Outcome 1 HIV infection status in the child.
2.2
2.2. Analysis
Comparison 2 Short course zidovudine versus placebo/no treatment (all trials), Outcome 2 Stillbirth.
2.3
2.3. Analysis
Comparison 2 Short course zidovudine versus placebo/no treatment (all trials), Outcome 3 Neonatal mortality.
2.4
2.4. Analysis
Comparison 2 Short course zidovudine versus placebo/no treatment (all trials), Outcome 4 Deaths after neonatal period.
2.5
2.5. Analysis
Comparison 2 Short course zidovudine versus placebo/no treatment (all trials), Outcome 5 Late deaths.
2.6
2.6. Analysis
Comparison 2 Short course zidovudine versus placebo/no treatment (all trials), Outcome 6 Maternal deaths.
2.7
2.7. Analysis
Comparison 2 Short course zidovudine versus placebo/no treatment (all trials), Outcome 7 Premature delivery.
2.8
2.8. Analysis
Comparison 2 Short course zidovudine versus placebo/no treatment (all trials), Outcome 8 Low birth weight.
2.9
2.9. Analysis
Comparison 2 Short course zidovudine versus placebo/no treatment (all trials), Outcome 9 Neonatal haematological toxicity.
2.10
2.10. Analysis
Comparison 2 Short course zidovudine versus placebo/no treatment (all trials), Outcome 10 Maternal haematological toxicity.
4.1
4.1. Analysis
Comparison 4 Short course zidovudine versus placebo/no treatment (breast feeding), Outcome 1 HIV infection status in the child.
4.2
4.2. Analysis
Comparison 4 Short course zidovudine versus placebo/no treatment (breast feeding), Outcome 2 Stillbirth.
4.3
4.3. Analysis
Comparison 4 Short course zidovudine versus placebo/no treatment (breast feeding), Outcome 3 Neonatal mortality.
4.4
4.4. Analysis
Comparison 4 Short course zidovudine versus placebo/no treatment (breast feeding), Outcome 4 Deaths after neonatal period.
4.5
4.5. Analysis
Comparison 4 Short course zidovudine versus placebo/no treatment (breast feeding), Outcome 5 Late deaths.
4.6
4.6. Analysis
Comparison 4 Short course zidovudine versus placebo/no treatment (breast feeding), Outcome 6 Maternal deaths.
4.7
4.7. Analysis
Comparison 4 Short course zidovudine versus placebo/no treatment (breast feeding), Outcome 7 Premature delivery.
4.8
4.8. Analysis
Comparison 4 Short course zidovudine versus placebo/no treatment (breast feeding), Outcome 8 Low birth weight.
4.9
4.9. Analysis
Comparison 4 Short course zidovudine versus placebo/no treatment (breast feeding), Outcome 9 Neonatal haematological toxicity.
4.10
4.10. Analysis
Comparison 4 Short course zidovudine versus placebo/no treatment (breast feeding), Outcome 10 Maternal haematological toxicity.
5.1
5.1. Analysis
Comparison 5 Caesarean section versus vaginal delivery, Outcome 1 HIV infection status in the child.
5.3
5.3. Analysis
Comparison 5 Caesarean section versus vaginal delivery, Outcome 3 Neonatal mortality.
5.4
5.4. Analysis
Comparison 5 Caesarean section versus vaginal delivery, Outcome 4 Deaths after neonatal period.
5.6
5.6. Analysis
Comparison 5 Caesarean section versus vaginal delivery, Outcome 6 Maternal deaths.
5.7
5.7. Analysis
Comparison 5 Caesarean section versus vaginal delivery, Outcome 7 Maternal postpartum complications.
6.1
6.1. Analysis
Comparison 6 HIVIG plus zidovudine versus IVIG plus zidovudine, Outcome 1 HIV infection status in the child.
6.2
6.2. Analysis
Comparison 6 HIVIG plus zidovudine versus IVIG plus zidovudine, Outcome 2 Stillbirth.
6.3
6.3. Analysis
Comparison 6 HIVIG plus zidovudine versus IVIG plus zidovudine, Outcome 3 Neonatal mortality.
6.4
6.4. Analysis
Comparison 6 HIVIG plus zidovudine versus IVIG plus zidovudine, Outcome 4 Deaths after neonatal period.
6.6
6.6. Analysis
Comparison 6 HIVIG plus zidovudine versus IVIG plus zidovudine, Outcome 6 Maternal deaths.
6.7
6.7. Analysis
Comparison 6 HIVIG plus zidovudine versus IVIG plus zidovudine, Outcome 7 Premature delivery.
6.8
6.8. Analysis
Comparison 6 HIVIG plus zidovudine versus IVIG plus zidovudine, Outcome 8 Low birth weight.
6.9
6.9. Analysis
Comparison 6 HIVIG plus zidovudine versus IVIG plus zidovudine, Outcome 9 Neonatal haematological toxicity.
7.1
7.1. Analysis
Comparison 7 Nevirapine versus zidovudine, Outcome 1 HIV infection status in the child.
7.2
7.2. Analysis
Comparison 7 Nevirapine versus zidovudine, Outcome 2 Neonatal mortality.
7.5
7.5. Analysis
Comparison 7 Nevirapine versus zidovudine, Outcome 5 Maternal deaths.
7.6
7.6. Analysis
Comparison 7 Nevirapine versus zidovudine, Outcome 6 Neonatal haematological toxicity.
7.7
7.7. Analysis
Comparison 7 Nevirapine versus zidovudine, Outcome 7 Maternal haematological toxicity.
See this image and copyright information in PMC

References

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