Interventions for reducing the risk of mother-to-child transmission of HIV infection

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PLEASE NOTE: This review should be considered obsolete and outdated. Instead of this review, please refer to the following Cochrane reviews: Read JS, Newell ML. Efficacy and safety of cesarean delivery for prevention of mother‐to‐child transmission of HIV‐1. Cochrane Database Syst Rev. 2005 Oct 19, Issue 4. Wiysonge CS, Shey MS, Sterne JA, Brocklehurst P. Vitamin A supplementation for reducing the risk of mother‐to‐child transmission of HIV infection. Cochrane Database Syst Rev. 2005 Oct 19, Issue 4. Wiysonge CS, Shey MS, Shang JD, Sterne JA, Brocklehurst P. Vaginal disinfection for preventing mother‐to‐child transmission of HIV infection. Cochrane Database Syst Rev. 2005 Oct 19, Issue 4. Volmink J, Siegfried NL, van der Merwe L, Brocklehurst P. Antiretrovirals for reducing the risk of mother‐to‐child transmission of HIV infection. Cochrane Database Syst Rev. 2007 Jan 24, Issue 1. Horvath T, Madi BC, Iuppa IM, Kennedy GE, Rutherford G, Read JS.. Interventions for preventing late postnatal mother‐to‐child transmission of HIV. Cochrane Database of Systematic Reviews 2009, Issue 1. Sturt AS, Dokubo EK, Sint TT. Antiretroviral therapy (ART) for treating HIV infection in ART‐eligible pregnant women. Cochrane Database of Systematic Reviews 2010 , Issue 3 . You may also wish to consult an "umbrella" review that covers some of the above (through 2007 publicaton): Bond K, Horváth T, Harvey K, Wiysonge CS, Read JS. The Cochrane Library and mother‐to‐child transmission of HIV: an umbrella review. Evidence‐based Child Health: A Cochrane Review Journal 2007;2:4‐24. ==================================== 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. 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. The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. 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. Trial quality assessments and data extraction were undertaken by the reviewer. 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). 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. 針對降低HIV(人類免疫缺乏病毒)母子垂直感染風險的介入性治療 請注意: 本篇文章(review)可能已經過時或是已被淘汰,請參考Cochrane以下的文章(review). Read JS, Newell ML. 對於避免HIV1(人類免疫缺乏病毒)母子垂直感染,剖腹生產的安全性及功效 Cochrane Database Syst Rev. 2005 Oct 19, Issue 4. Volmink J, Siegfried NL, van der Merwe L, Brocklehurst P. 以抗反轉錄病毒藥物來降低HIV(人類免疫缺乏病毒)母子垂直感染的風險Cochrane Database Syst Rev. 2007 Jan 24, Issue 1. Wiysonge CS, Shey MS, Sterne JA, Brocklehurst P.以維他命A來降低HIV病毒母子垂直感染的風險Cochrane Database Syst Rev. 2005 Oct 19, Issue 4. Wiysonge CS, Shey MS, Shang JD, Sterne JA, Brocklehurst P. 以陰道消毒來降低HIV病毒母子垂直感染的風險Cochrane Database Syst Rev. 2005 Oct 19, Issue 4. 另外一篇Cochrane關於以餵食介入避免HIV病毒親子傳染的文章正在進行中,在2007後半年應該就會完成. 針對以上文章,可以用‘umbrella’ review 查到 Bond K et al. Cochrane資料庫與HIV的親子傳染: 一篇umbrella review. 以證據為導向的兒童健康:一篇Cochrane review文章, vol. 2, issue 1. 到1998年結束為止,超過3千3百萬的人感染了人類免疫缺乏病毒以及超過1百萬個小孩被其母親傳染. 這篇文章的目的主要是去評估何種介入性治療可以有效的降低HIV母子垂直感染的風險,以及這些治療對於母親及小孩的死亡率及罹病率有何影響 針對Cochrane有登記的‘懷孕及分娩’試驗以及有登記的控制試驗(controlled trial)進行搜尋 所選擇的試驗必須是隨機試驗(Randomised trials), 而這些試驗包含了:...

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