prevmothertochildtransofhiv（ppt32）-經(jīng)營(yíng)管理-全文預(yù)覽
【正文】 Cost Efficacy (transmission rate) Ivory Coast and Burkina Faso DITRAME ANRS 049 Antepartum: 300mg BID at 3638 wks Intrapartum: 600mg Q3H Postpartum: 300mg BID X 1 wk $210360 18% vs. % at 6 months Combined analysis of these two studies: % vs. % at 15 months Ivory Coast Antepartum: 300mg BID at 36 wks Intrapartum: 300mg Q3H $200400 At 3 months % vs. % 來(lái)自 料庫(kù)下載 PETRA trial (with breastfeeding) antepartum: 300 mg AZT BID + 3TC 150 mg BID start at 36 wks intrapartum: AZT 300 mg Q3H + 3TC 150 mg Q12H postartum: 300 mg AZT BID + 3TC 150 mg BID for 1 week US Cost Transmission in treatment group Transmission in control group Ante/intra/post partum $600 6% at 6 weeks 22% at 18 months 15% at 6 weeks 22% at 18 months Intra/post partum only $600 9% at 6 weeks % at 18 months 15% at 6 wks 22% at 18 months Intrapartum only $85 15% at 6 weeks 20% at 18 months 15% at 6 wks 22% at 18 months 來(lái)自 料庫(kù)下載 HIV NET012 (with breastfeeding) Regimen US Cost Efficacy HIV NET 012 2 dose nevirapine Nevirapine Intrapartum: 200 mg Postpartum: 2 mg/kg oral dose at 4872 hours ?$4 USD ? Simple ? Directly observed therapy possible 12% vs. 21% at 16 weeks (control group received intrapartum and 7 days postpartum ZDV and 3TC) 13% vs. 24% at 18 months 來(lái)自 料庫(kù)下載 Concerns About Resistance with Two Dose Nevirapine Regimens ? 3/15 studied women had K103N nevirapine resistance mutation at 6 weeks ? Mutation had disappeared at 33 weeks in one woman studied ? No evidence to suggest that this increases transmission or speeds progress of disease ? Without the selective pressure of ongoing nevirapine monotherapy, the quasispecies will remain at low levels and unlikely to be transmitted 來(lái)自 料庫(kù)下載 Future Hopes ? Neonatal only regimens ? Nonantiretroviral Interventions – Virucidal cleansing of infant and the mother?s vaginal canal – Nutritional supplementation – Prophylaxis of subclinical chorioamnionitis 來(lái)自 料庫(kù)下載 Where to go next ? Promote routine antenatal care for all women ? Promote role of women ? Promote condom use ? Promote routine HIV1 counseling and testing ? Improve avail
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