RESUMEN
OBJECTIVE: To investigate whether costs of multidose antiretroviral regimens (MD-ARVs), including highly active antiretroviral therapy (HAART), for prevention of mother-to-child transmission (PMTCT) of HIV might be offset by savings gained from treating fewer perinatally acquired infections. METHODS: Rates of MTCT reported in the Dominican Republic among mother-infant pairs treated with single-dose nevirapine (SD-NVP; n=39) and MD-ARVs (n=91) for PMTCT were compared. Annual births to women infected with HIV were estimated from seroprevalence studies. Antiretroviral costs for both PMTCT and for HAART during the first 2 years of life (in cases of perinatal infection) were based on 2008 low-income country price estimates. RESULTS: Rates of MTCT were 3.3% and 15.4% for the MD-ARV and SD-NVP groups, respectively (P=0.02). Assuming that 5775 of 231 000 annual births (2.5%) were to HIV-positive women, it was estimated that 191 perinatally acquired infections would occur using MD-ARVs and 889 using SD-NVP. High costs of maternal MD-ARVs (HAART, US$914,760 versus SD-NVP, $1155) would be offset by lower 2-year HAART costs ($250,344 versus $1,168,272 for infants in the SD-NVP group) for the lower number of children with prenatally acquired infection (191 versus 889) associated with the use of MD-ARVs for PMTCT (net national saving $3168). CONCLUSION: Despite the high costs, use of MD-ARVs, such as HAART, for PMTCT offer societal savings because fewer perinatally acquired infections are anticipated to require treatment.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Benzoxazinas/uso terapéutico , Infecciones por VIH/transmisión , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Lamivudine/uso terapéutico , Nevirapina/uso terapéutico , Zidovudina/uso terapéutico , Alquinos , Fármacos Anti-VIH/economía , Terapia Antirretroviral Altamente Activa , Benzoxazinas/economía , Análisis Costo-Beneficio , Ciclopropanos , República Dominicana , Esquema de Medicación , Costos de los Medicamentos , Femenino , Infecciones por VIH/economía , Infecciones por VIH/prevención & control , Humanos , Transmisión Vertical de Enfermedad Infecciosa/economía , Lamivudine/economía , Nevirapina/economía , Embarazo , Segundo Trimestre del Embarazo , Tercer Trimestre del Embarazo , Zidovudina/economíaRESUMEN
The evidence behind the World Health Organization guidelines that BCG vaccination should not be used in HIV-infected children is compelling. We report three cases of severe BCG-associated immune reconstitution syndrome in HIV-infected infants and describe measures available in developing countries that prevent inadvertent BCG immunization in these infants.