Abstract
The efficacy of a short-term regimen of zidovudine (ZDV) in preventing perinatal HIV transmission was investigated in a randomized case-placebo study conducted at two teaching hospitals in Bangkok Thailand in 1996-97. The 198 women in the intervention group were given 300 mg of ZDV orally twice a day from 38 weeks of gestation until the onset of labor and 300 mg every 3 hours thereafter until delivery. Another 199 women received a placebo. Infants in both groups were fed formula rather than breast milk. At 6 months of age 52 children (17 from the ZDV group and 35 in the placebo group) were HIV-positive; all HIV infections were evident at 2 months of age. The HIV transmission risk was 9.2% (95% CI 5.0-13.5%) in the ZDV group and 18.6% in the placebo group (95% CI 13.0-24.0%) signifying a 51% decrease in risk. The ZDV regimen used in this study is more feasible for implementation in developing country settings than the one currently used in the US (associated with a 66% reduction in HIV transmission): it costs US$50 starts later in pregnancy involves less frequent dosing and oral dosing during labor and does not involve infant treatment. On the basis of these findings ministries of health and donor agencies are urged to develop strategies to increase access to prenatal HIV testing and ZDV treatment for HIV-infected pregnant women in resource-poor settings. Further evaluation is needed of the effect of breast feeding on the efficacy of this regimen.
Highlights
SICKLE CELL disease (SCD) is an autosomal recessive disorder characterized by production of abnormal hemoglobin, resulting in anemia, susceptibility to pneumococcal and other infections, pain, stroke, and multiple organ dysfunctions
A randomized controlled trial published in 1986 indicated that daily oral penicillin prophylaxis reduced the incidence of serious infection in young children with SCD and led to widespread adoption of newborn screening programs for SCD.2
In California and Illinois, mortality from all causes among black children born during 1990-1994 with SCD was slightly less than overall mortality for all black children born in the same time period
Summary
SICKLE CELL disease (SCD) is an autosomal recessive disorder characterized by production of abnormal (sickle) hemoglobin, resulting in anemia, susceptibility to pneumococcal and other infections, pain, stroke, and multiple organ dysfunctions. Mortality data was available until the third birthday for the subgroup of 768 children with presumed or confirmed hemoglobin SS disease born during 19901991 in New York and during 1990-1992 in California and Illinois Of these 768 children, 1.0% died as a result of SCD-related causes during the first 3 years of life (0.35 per 100 person-years, based on 2258 person-years [95% confidence interval=0.150.70 per 100 person-years]). In a study of U.S death certificates for 19681992, mortality among black children aged 1-4 years who had SCD declined significantly.5 This trend occurred at the same time as the establishment of newborn screening programs, more comprehensive care and parental education, widespread acceptance of penicillin prophylaxis after publication of the randomized trial in 1986, and new vaccinations. California, Illinois, New York, and Maryland, comprehensive medical care and JAMA, April 8, 1998—Vol 279, No 14
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