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Original Research
Similar HIV protection from four weeks of zidovudine versus nevirapine prophylaxis among formula-fed infants in Botswana
Submitted: 21 March 2017 | Published: 28 March 2018
About the author(s)
Kathleen M. Powis, Massachusetts General Hospital, Departments of Medicine and Pediatrics, United States; Harvard T. H. Chan School of Public Health, Department of Immunology and Infectious Diseases, United States; Botswana Harvard AIDS Institute Partnership, Gaborone, BotswanaShahin Lockman, Harvard T. H. Chan School of Public Health, Department of Immunology and Infectious Diseases, United States; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Brigham and Women’s Hospital, Infectious Disease Division, United States
Gbolahan Ajibola, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
Michael D. Hughes, Harvard T. H. Chan School of Public Health, Department of Immunology and Infectious Diseases, United States
Kara Bennett, Bennett Statistical Consulting, Inc, Ballston Lake, United States
Jean Leidner, Goodtables Data Consulting, Norman, United States
Oganne Batlang, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
Kerapetse Botebele, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
Sikhulile Moyo, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
Erik van Widenfelt, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
Joseph Makhema, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
Chipo Petlo, Ministry of Health, Gaborone, Botswana
Haruna B. Jibril, Ministry of Health, Gaborone, Botswana
Kenneth McIntosh, Division of Infectious Diseases, Boston Children’s Hospital, United States
Max Essex, Harvard T. H. Chan School of Public Health, Department of Immunology and Infectious Diseases, United States; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
Roger L. Shapiro, Harvard T. H. Chan School of Public Health, Department of Immunology and Infectious Diseases, United States; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
Abstract
Background: The World Health Organization HIV guidelines recommend either infant zidovudine (ZDV) or nevirapine (NVP) prophylaxis for the prevention of intrapartum motherto-child HIV transmission (MTCT) among formula-fed infants. No study has evaluated the comparative efficacy of infant prophylaxis with twice daily ZDV versus once daily NVP in exclusively formula-fed HIV-exposed infants.
Methods: Using data from the Mpepu Study, a Botswana-based clinical trial investigating whether prophylactic co-trimoxazole could improve infant survival, retrospective analyses of MTCT events and Division of AIDS (DAIDS) Grade 3 or Grade 4 occurrences of anaemia or neutropenia were performed among infants born full-term (≥ 37 weeks gestation), with a birth weight ≥ 2500 g and who were formula-fed from birth. ZDV infant prophylaxis was used from Mpepu Study inception. A protocol modification mid-way through the study led to the subsequent use of NVP infant prophylaxis.
Results: Among infants qualifying for this secondary retrospective analysis, a total of 695 (52%) infants received ZDV, while 646 (48%) received NVP from birth for at least 25 days but no more than 35 days. Confirmed intrapartum HIV infection occurred in two (0.29%) ZDV recipients and three (0.46%) NVP recipients (p = 0.68). Anaemia occurred in 19 (2.7%) ZDV versus 12 (1.9%) NVP (p = 0.36) recipients. Neutropenia occurred in 28 (4.0%) ZDV versus 21 (3.3%) NVP recipients (p = 0.47).
Conclusions: Both ZDV and NVP resulted in low intrapartum transmission rates and no significant differences in severe infant haematologic toxicity (DAIDS Grade 3 or Grade 4) among formula-fed full-term infants with a birthweight ≥ 2500 g.
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