GYNECOLOGY &OBSTETRICS

International Journal of Gynecology & Obstetrics 61 (1998) 65-66

Brief communication

HIV, maternal anemia and perinatal intervention using zidovudine

N. Meda”T* , B. Daob, A. Ouangr6”l’ for the DITRAME Study Group (ANRS 049 Clinical Trial)

‘Centre MURAZ, Organisation de Coordination et de Coophation pour la lutte contre les Grandes End&es (OCCGE), Bobo-Diouhso, Burkina Faso

bDepartment of Gynecology and Obstetrics, Centre Hospitalier National Sour6 Sanou, Bobo-Dioulasso, Burkina Faso

Received 9 September 1997; received in revised form 29 December 1997; accepted 7 January 1998

Keywords: Anemia; Pregnancy; HIV infection; Prevalence; Mother-to-child HIV transmission; Zidovudine; Burkina Faso

Anemia, as defined by the World Health Orga- nization by hemoglobin level (Hb) less than 11 g/d& occurs in 40-80% of pregnant women in Africa [ 11. Human Immunodeficiency Virus (HIV) infection has become an important potential cause of maternal anemia, as well as a major public health problem for mothers and children in Africa [2,3]. Zidovudine (ZDV) has been shown to be effective in industrialized countries in reducing mother-to-child transmission (MTCT) of HIV, but its impact on transmission is yet unknown in Africa where breast-feeding is the norm [4]. Be- cause ZDV has hematologic toxicity, maternal anemia is of particular concern when considering the use of ZDV in Africa as an intervention to decrease MTCT of HIV. We performed, as part of a research program including a clinical trial of perinatal ZDV, a cross-sectional survey in 1995-1996 in Bobo-Dioulasso (Burkina Faso) to

*Corresponding author. Tel.: +27 226 972630; fax: + 27 226 970177; e-mail: griv.muraz@fasonet.bf

‘The DITRAME Study Group is organized as follows: Coordination: INSERM U 330, Universitd Victor Segalen Bordeaux 2, Bordeaux, France (Fransois Dabis). Principal investigators: Maternite Cochin Port-Royal, Paris, France (Laurent Mandelbrot), Centre Hospitalier Universitaire de Yopougon, Abidjan, C&e d’Ivoire (Christiane Welffens-Ekra). Abidjan Center (C&e d’Ivoire): CeDReS, Centre Hospitalier Universitaire de Treichville (Patrice Combes, Fatoumata Sylla-Koko, Dominique Bonard, Bruno You); Centre Hospi- talier Universitaire de Yopougon (Marguerite Timite); DI- TRAME Project (Rosa Ramon); ORSTOM Petit Bassam (Philippe Msellati). Bobo-Dioulasso Center (Burkina Faso): Centre MURAZ/OCCGE (Michel Cartoux, Lucile Gautier- Charpentier, Nicolas Meda, Amadou OuangrC, Arlette Simonon); Centre Hospitalier National Sour6 Sanou (Andre Jules BaziC, Blami Dao, Boubacar Nacro, Franqois Tall). Methodology: INSERM U 330, Bordeaux, France (Valtriane Leroy, Roger Salamon); Centre MURAZ/OCCGE (Philippe Van de Perre); Laboratoire de Virologie, Hopital Necker-En- fants Malades, Paris, France (Christine Rouziouxl. The DI- TRAME project was established in Abidjan (Cote d’Ivoire1 and Bobo-Dioulasso (Burkina Faso) with grants from the Agence Nationale de Recherches sur le SIDA (ANRS) and the French Ministry of Cooperation within the ANRS Coordi- nated Action no 12 in collaboration with the National AIDS Control Programmes of Cote d’lvoire and Burkina Faso.

0020-7292/98/$19.00 0 1998 International Federation of Gynecology and Obstetrics PIZ SOO20-7292(98)00016-2

66 N. Meda et al. /International Journal of Gynecology & Obstetrics 61 (1998) 65-66

Table 1 Severity of anemia during pregnancy (level of hemoglobin < 11 g/dl) according to HIV serostatus (Bobo-Dioulasso, Burkina Faso, 199551996)

Severity of anemia Anemic pregnant women (%)*

HIV-positive (n = 171)

HIV-negative (n = 1353)

Mild (10 g/d1 I hemoglobin < 11 g/dl) 41.5 47.3 Moderate (7 g/d1 5 hemoglobin < 10 g/dl) 54.4 50.3 Severe (hemoglobin < 7 g/dl) 4.1 2.4

*P = 0.19; x2 test with two degrees of freedom.

determine the effect of HIV infection on the prevalence and severity of maternal anemia.

Voluntary and confidential HIV testing was offered to pregnant women 18 years old or more with gestational age below 7 months. Hemograms were performed for women who consented to serologic testing.

Among 2667 women who accepted HIV testing, Hb level was available for 2308. The prevalence of HIV infection was 9.7% (95% Confidence In- terval, CI: 8.6-10.8%). The prevalence of anemia was 66% (95% CI: 64-68%). The prevalence of mild (10 < Hb < ll>, moderate (7 I Hb < 10) and severe anemia (Hb < 7 g/d11 was 30.8, 33.5 and 1.7%, respectively. There was a relation between HIV infection and anemia: the prevalence of anemia was 78.4% in HIV-infected women vs. 64.7% in HIV-negative women (P < 0.001). How- ever, the severity of anemia was independent of HIV serostatus (Table 1).

Our study shows that two-thirds of the preg- nant women living in Bobo-Dioulasso are anemic confirming data from other developing countries [1,2]. HIV infection was closely related to anemia in pregnant women. It is known that HIV infec- tion causes pancytopenia [2]. Most of hematologic

changes occur with advanced HIV disease. In our population, most of the HIV-infected pregnant women were asymptomatic, without immune deficiency (data not shown). This may explain why the prevalence of severe anemia was not signifi- cantly higher in HIV-infected than in HIV-nega- tive women. In such conditions, ZDV can be expected to be well tolerated, especially if given during a short period [4]. Whether such a treat- ment will be efficacious in reducing MTCT of HIV remains to be demonstrated.

References

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World Health Organization. The prevalence of anemia in women: a tabulation of available information. 2nd ed. Geneva: WHO/MCH/MSM, 19922. Fleming AF. Haematological diseases in the tropics. In: Cook GC, editor. Manson’s tropical diseases. 20th ed. London: Saunders, 1996:101-173. Temmerman M, Chomba EN, Piot P. HIV-l and repro- ductive health in Africa. Int J Gynecol Obstet 1994;44:107-112. Van de Perre P, Meda N, Car-tour M et al. Zidovudine and breast-feeding. AIDS Patient Care STDs 1997;ll: 4-5.