Intervention study to reduce Mother-to-child transmission of HIV | ICRH

TEAM MEMBERS 

Philippe Gaillard; Fabian Mwanyumba; Patricia Claeys; Marleen Temmerman;

PERIOD 

04/03/2001-04/03/2003

PARTNERS

• Chris Verhofstede, AIDS Reference Laboratory, Ghent University
• Varsha Chohan, Coast Provincial General Hospital, Mombasa, Kenya
• Kishorchandra Mandaliya, Coast Provincial General Hospital, Mombasa, Kenya
• Jeckoniah Ndinya-Achola, Dept of Medical Microbiology, University of Nairobi, Kenya

OBJECTIVES

• To examine whether the intervention strategy of vaginal cleansing with a diluted chlorhexidine solution during labour can reduce the risk of transmission of HIV infection from mother-to-child
• To acquire a better understanding of the timing of perinatal transmission of HIV-1.

METHODS 

• Prospective clinical trial
• On alternating weeks, women were allocated to non-intervention or to intervention consisting of vaginal lavage with 120 ml 0.2% chlorhexidine, later increased to 0.4%, repeated every 3 h from admission to delivery. Infants were tested for HIV by DNA polymerase chain reaction within 48 h and at 6 and 14 weeks of life.

RESULTS

• Enrolment and follow-up data were available for 297 and 309 HIV-positive women, respectively, in the non-lavage and the lavage groups.
• Vaginal lavage with diluted chlorhexidine during delivery did not show a global effect on MTCT in our study. However, the data suggest that lavage before the membranes are ruptured might be associated with a reduction of MTCT, especially with higher concentrations of chlorhexidine:
• There was no evidence of a difference in intrapartum MTCT (17.2 versus 15.9%, OR 0.9, 95% CI 0.6-1.4) between the groups.
• Lavage solely before rupture of the membranes tended towards lower MTCT with chlorhexidine 0.2% (OR 0.6, 95% CI 0.3-1.1), and even more with chlorhexidine 0.4% (OR 0.1, 95% CI 0.0-0.9). 
• The results were published in AIDS. 2001 Feb 16;15(3):389-96