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Short Courses of Zidovudine May Reduce Perinatal HIV Transmission.

A regimen of zidovudine given to an HIV-infected woman during pregnancy, labor, and delivery and continued in the newborn for six weeks can reduce perinatal transmission rates of HIV infection by two thirds (see JW Dec 1 1994, p. 81, accession number 941115001, and N Engl J Med 1994; 331:1173). This study asked if equally impressive results might be obtained with shorter regimens.

The results of polymerase chain reaction HIV testing in 454 infants born to HIV-infected mothers in New York state from 1995 to 1997 were correlated with the schedule of zidovudine each mother-infant pair took. Some mothers had taken the recommended schedule; others had declined zidovudine during pregnancy or had received no prenatal care; in others, HIV infection was not discovered until the child was born.

In 95 mother-infant pairs who received no zidovudine prophylaxis, 30 infants were infected with HIV, for a transmission rate of 31.6 percent. Corresponding rates for those receiving zidovudine starting three days or more after birth, within 48 hours of birth, during labor, and prenatally were 25.0 percent, 9.5 percent, 5.3 percent, and 5.0 percent, respectively.

Comment: These observational data fail to control for variables associated with decreased risk for perinatal HIV transmission, including the mother's stage of disease and mode of delivery. Still, an editorialist notes, they confirm other studies suggesting that most perinatal HIV transmission occurs during delivery and that short perinatal or postnatal courses of zidovudine may work well.

— A Zuger

Published in Journal Watch General Medicine November 17, 1998

Citation(s):

Wade NA et al. Abbreviated regimens of zidovudine prophylaxis and perinatal transmission of the human immunodeficiency virus. N Engl J Med 1998 Nov 12 339 1409-1414.

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McIntosh K. Short (and shorter) courses of zidovudine. N Engl J Med 1998 Nov 12 339 1467-1468.

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