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Monday July 17, 2006 (Reuters Health) - In a resource-limited setting, short courses of the nucleoside analogues stavudine, didanosine or zidovudine can help prevent mother-to-child transmission of HIV, according to researchers in South Africa.
Lead investigator Dr. Glenda Gray told Reuters Health that the study was designed at a time when zidovudine "was very expensive, and we were looking for alternatives to this regimen. Our study demonstrated that short course nucleoside analogues ... were all as efficacious as each other, and could be used as an alternative."
As described in the June issue of the Journal of Acquired Immune Deficiency Syndromes, Dr. Gray of Chris Hani Baragwanath Hospital, Soweto, and colleagues conducted an open-label study in which 373 pregnant women were randomized to stavudine, didanosine or zidovudine or to stavudine in combination with didanosine.
Women began treatment at around 34 weeks. This was continued through delivery and infants were treated for 6 weeks.
After the start of treatment, HIV-1 RNA levels dropped rapidly in all treatment groups.
At 24 weeks after delivery, in the 362 evaluable mother-infant pairs, HIV infection was seen in 11 of the stavudine infants, 10 in the didanosine group, 5 in the zidovudine group and 4 in the combination group. Eleven infections occurred in utero.
Dr. Gray noted that "prolonged use of stavudine, and stavudine in combination with didanosine, can lead to metabolic complications, and thus prolonged use is not normally recommended in pregnancy."
However, she concluded, "As this course is only 4 weeks long, the dangers of metabolic complications are less, and give women and other care providers more options when zidovudine may not be an option."
