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The Journal of AIDS Research Vol.. No. +,**, 1- HIV HIV +* +5*** HIV ACTG*10 ACTG*10 *4**/ /*,5.*0 /*.52*- +**4.2 /*.5/+1 +**4., /*.53*. +**4/* /*/5*-/ +**4/, *4*+ /*/5,,1 +**4-+ /*-500- /*.50/- +**4,* /*/5.,2 +**4-/ /*/503* +**4.* *4*/ /+-51+. /*250+- 334*+ /*051.0 324./ /*350,+ 334,* /+*53-, 334.0 *4+* /,05,2, /+,52.1 314./ /*15++- 304-2 /+.520, 3142- /+15.2/ 324-- *4/* 0,053-. /.051-* 214,+ /+25*.. 2,40- //052++ 2242+ /0353-2 3*43+ +4** 1/-5*-- /235++. 124,- /-+51++ 1*40+ 0*35,3. 2*43+ 0-/5/2+ 2.4.* HIV HIV HIV HIV HAART 2, 3 HAART HIV HIV HAART HAART HIV HIV HIV HIV 1* 2* HIV HIV b HIV C. J. Murray Disabilityadjusted life-years DALYs +*+- DALYs HIV HIV HIV HIV HIV HIV HIV c, -- --
J Inaba et al. :Evaluation of the Most Adequate Prevention Strategy of HIV Mother-to-Child Transmission in Japan, through Computer Simulation HIV + +./ HIV AZT AZT Nevirapine AZT, Nevirapine, - - HIV -0-0 -1 HIV d HIV HIV DNA HIV HIV HIV HIV 0 1 HIV ACTG*10 AZT *.**0 HIV *.-1. HIV / HIV HIV ACTG*10 HIV *.*+ HIV HIV HIV *.. HIV HIV HIV HIV HIV ACTG*10 HIV + HIV :HIV-+,***, Connor EM, Sperling RS, Gelber R, Kiselev P, Scott G, O Sullivan MJ, VanDyke R, Bey M, Shearer W, Jacobson RL : Reduction of maternal-infant transmission of human immunodeficiency virus type + with zidovudine treatment : Pediatric AIDS Clinical Trials Group Protocol *10 Study Group. N Engl J Med, --+ : ++1-++2*, +33.. - Mandelbrot L, Le Chenadec J, Berrebi A, Bongain A, -. -.
The Journal of AIDS Research Vol.. No. +,**, Benifla J-L, Delfraissy J-F, Blanche S, Mayaux M-J : Perinatal HIV-+ transmission interacton between zidovudine prophylaxis and mode of deliverry in the french perinatal cohort. JAMA,,2* : //0*, +332.. HIV : HIV-+ HIV +333 / The European Mode of Delivery Collaboration : Elective caesarean-section versus vaginal delivery in prevention of vertical HIV-+ transmission : a randomized clinical trial. Lancet, -/- : +*-/+*-3, +333. 0 Guay LA, Musoke P, Fleming T, Bagenda D, Allen M, Nakabiito C, Sheman J, Bakaki P, Ducar C, Deseyve M, Emel L, Mirochnick M, Fowler MG, Mofenson L, Miotti P, Dransfield K, Bray D, Mmiro F, Jackson JB : Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-+ in Kampala, Uganda : HIVNET *+, randomised trial. Lancet, -/. : 13/2*,, +333. 1 Marseille E, Kahn JG, Mmiro F, Guay L, Musoke P, Fowler MG, Jackson JB : Cost e#ectiveness of singledose nevirapine regimen for mothers and babies to decrease vertical HIV-+ transmission in sub-saharan Africa. Lancet -/. : 2*-2*3, +333. 2 Berger EA, Moss B, Pastan I : Reconsidering targeted toxins to eliminate HIV infection : Yo gotta have HAART. Proc Natl Acad Sci USA 3/ (,*) :++/++ ++/+-, +332. 3 Zorrilla CD : Mother-to-child HIV-+ transmission : state of the art and implications for public policy. P R Health Sci J +3 (+) :,3-.,,***. +* Murray CJ : Quantifying the burden of disease : the technical basis for disability-adjusted life years. Bull World Health Organ 1, (-) :.,3../, +33.. ++ Murray CJL, Lopes AD : Global mortality, disability, and the contribution of risk factors : Global Burden of Disease Study. Lancet -.3 : +.-0+..,, +331. +, Cost-e#ectiveness analysis and HIV/AIDS : UNAIDS Technical update. UNAIDS Best Practice Collection, +332. +- Prevention of HIV transmission from mother to child : Strategic options. UNAIDS Best Practice Collection, +333. -/ -/
J Inaba et al. :Evaluation of the Most Adequate Prevention Strategy of HIV Mother-to-Child Transmission in Japan, through Computer Simulation Evaluation of the Most Adequate Prevention Strategy of HIV Mother-to-Child Transmission in Japan, through Computer Simulation Junichi INABA +),.,Akari NAGAMATSU +,Shigeki MINOURA +, Hirofumi MIYAZAWA,,Akira YASUOKA -, Shinichi OKA - and Toru CHOSA. + International Medical Center of Japan, Obstetrics & Gynecology, International Medical Center of Japan, Pediatrics - International Medical Center of Japan, AIDS Clinical Center. International Medical Center of Japan, Bureau of International Cooperation Objective :The purpose of this study is to investigate the most cost e#ective strategy for the Prevention of HIV Mother-to-Child Transmission (PMCT) in Japan. Methods :Acomprehensive computer simulation method with Microsoft Excel,*** was used in this study. We selected the four well-known PMCT protocols ; +) ACTG*10,,) ACTG*10Elective Caesarian Section (C/S), -) Elective C/S only, and.) HIVENT*+,. The total PMCT cost was defined as the sum of the indirect prevention costs like regular antenatal (or prenatal) check ups and direct prevention costs including maternal HIV test, labor expenses, medication fees, baby formula, PCR tests and C/S expenses. No prevention strategy was also simulated as a control. Every cost was calculated based on the national health insurance credits. Each vertical transmission rate was quoted from past large-scale studies. The e#ectiveness of every prevention strategy was evaluated with both the expected number of non-infected infants through each strategy and its total PMCT cost. The reported current HIV prevalence rate among pregnant women in Japan is about *.*, ;however, we also investigated on the assumption that will be from *.**/ to +.* respectively to simulate future HIV prevalence situations in Japan. Results : When the HIV prevalence rate surpassed *.*,, ACTG*10elective C/S showed the most cost e#ective result, on the condition that the life-long medication cost per one HIV-infected child is 1/ million yen (equal to nearly US$0-*,***). When the prevalence rate was *.*, and below, however, there were no significant di#erence among strategies. Conclusion : ACTG*10elective C/S will be the most cost-e#ective and morally acceptable strategy to cope with the prospective increase of HIV-positive pregnancy in Japan in the future as well as in the current situation. Key words : HIV/AIDS, PMCT (PMTCT), cost-benefit ratio, ACTG*10, elective C/S -0-0