Vaginal lavage with chlorhexidine during labour to reduce mother-to-child HIV transmission: clinical trial in Mombasa, Kenya

Objectives: To evaluate the effect of vaginal lavage with diluted chlorhexi dine on mother-to child transmission of HIV (MTCT) in a breastfeeding popul ation. Methods: This prospective clinical trial was conducted in a governmental ho spital in Mombasa, Kenya. 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 admissi on to delivery. infants were tested for HIV by DNA polymerase chain reactio n within 48 h and at 6 and 14 weeks of life. Results: Enrolment and follow-up data were available for 297 and 309 HIV-po sitive women, respectively, in the non-lavage and the lavage groups. There was no evidence of a difference in intrapartum MTCT (17.2 versus 15.9%, OR 0.9, 95% Cl 0.6-1.4) between the groups. Lavage solely before rupture of th e membranes tended towards lower MTCT with chlorhexidine 0.2% (OR 0.6, 95% Cl 0.3-1.1), and even more with chlorhexidine 0.4% (OR 0.1, 95% Cl 0.0-0.9) . Conclusion: The need remains for interventions reducing MTCT without HIV te sting, often unavailable in countries with a high prevalence of HIV. Vagina l lavage with diluted chlorhexidine during delivery did not show a global e ffect on MTCT in our study. However, the data suggest that lavage before th e membranes are ruptured might be associated with a reduction of MTCT, espe cially with higher concentrations of chlorhexidine. (C) 2001 Lippincott Wil liams & Wilkins.