<i>The Cochrane Library</i> and mother‐to‐child transmission of HIV: an umbrella review
Bibliographic record
Abstract
Abstract Background The majority of HIV‐infected children acquire the infection from their mothers. Preventing mother‐to‐child transmission (MTCT) of HIV is a key step in reducing the number of paediatric HIV infections. Objective To summarize the Cochrane reviews which have assessed the efficacy of interventions to prevent MTCT of HIV. Methods The Cochrane Database of Systematic Reviews was searched for any intervention to prevent MTCT of HIV. Data were extracted in duplicate and the GRADE assessment tool used to analyze the quality of extracted data. Main Results Five reviews met our inclusion criteria, and were of medium to high quality. One review examined the efficacy of antiretroviral prophylaxis for preventing MTCT of HIV. Each regimen used, ranging from the two‐dose nevirapine regimen to combination regimens, such as zidovudine and lamivudine, reduced the risk of MTCT of HIV. A meta‐analysis was not conducted as different regimens were used in the different trials. Caesarean section before labour and before ruptured membranes reduces the risk of MTCT of HIV (risk ratio [RR] 0.34, 95% confidence interval [CI] 0.14 to 0.8) compared to vaginal delivery. There was no evidence that vaginal disinfection (RR 0.94; 95%CI: 0.71 to 1.25), vitamin A supplementation (RR 1.10; 95%CI: 0.95 to 1.26), or hyperimmune HIV immunoglobulin (RR 0.67; 95%CI: 0.29 to 1.55) are efficacious interventions for the prevention of MTCT of HIV. There was no review on alternatives to breastfeeding. Authors' Conclusions Antiretroviral prophylaxis and caesarean section before labour and before ruptured membranes are efficacious in reducing the risk of MTCT of HIV. However, there is a need for research directed at (1) simplifying antiretroviral regimens to facilitate adherence and to minimize toxicity for both mothers and infants, (2) assessing the long‐term impact of drug resistance on future treatment of HIV‐infected mothers and infants, and identifying regimens that are less likely to induce resistance, and (3) assessing the efficacy of caesarean section among HIV‐infected women with undetectable viral loads or who are receiving combination antiretroviral regimens. Copyright © 2007 John Wiley & Sons, Ltd.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.052 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.012 | 0.007 |
| Bibliometrics | 0.015 | 0.021 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.010 | 0.006 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.006 | 0.003 |
| Insufficient payload (model declined to judge) | 0.013 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".