#84-S short course antiretroviral treatment in the prevention of perinatal HIV-1 transmission: A meta-analysis of randomized controlled trials

PURPOSE: To evaluate efficacy of a short course nucleoside reverse transcriptase inhibitor (NRTI) antiretroviral treatment in the prevention of perinatal HIV-1. METHODS: Studies published prior to January 2002 were searched using computerized databases and manual methods. Randomized, placebo-controlled trials of short course NRTI treatment in pregnant HIV-infected women were included in the analysis. Study quality was assessed by one of the reviewers using a previously validated scale. Characteristics of study design and participants, treatment regimens, and outcomes were independently extracted by two reviewers. Odds ratio, absolute risk difference, and number needed-to-treat were estimated to evaluate the efficacy of NRTI. Due to homogeneity in risk estimates across studies, the fixed-effects model was used in analysis. Sensitivity analyses were performed to determine whether the pooled estimates were robust to different study and participant characteristics. A series of multivariate linear regression models were performed to explore the influence of covariates on the effects of the antiretroviral treatment and perinatal HIV-1 transmission. The potential for publication bias was examined using a funnel plot. RESULTS: Data were analyzed for 7 eligible (out of 9 initially identified) clinical trials with 2,468 participants. Treatment was associated with a 41% proportional reduction in perinatal HIV-1 transmission (odds ratio[OR], 0.59; 95% confidence interval [CI], 0.49–0.73; p < 0.0001). The treatment was associated with an absolute risk reduction of 67 per 1000 persons (95% CI, 40–94; p < 0.0001) for perinatal HIV-1 transmission. The number needed to treat (NNT) to prevent one event was 15 (95% CI, 10–25) for perinatal HIV-1 transmission. Treatment with intrapartum antiretroviral treatment alone was not significantly associated with a decline in perinatal HIV transmission (OR, 0.98; 95% CI, 0.66–1.48; P = 0.5). CONCLUSION: These results confirm the findings of individual studies that short course NRTI treatment decreases the risk of perinatal HIV transmission.