Effect of zidovudine on perinatal HIV-1 transmission and maternal viral load

De, Shapiro; Rs, Sperling; Rw, Coombs

doi:10.1016/s0140-6736(99)00122-1

Cited by 23 publications

(9 citation statements)

References 5 publications

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“…In the multivariate analysis, including timing of antiretroviral therapy initiation, the only variable that correlated significantly with MTCT was the use of zidovudine. In fact, intrauterine transmission in the PACTG 076 study was 2% [16], similar to the 1.6% found by Lallement et al [13], who used zidovudine alone starting at 28 weeks of gestation. Therefore, intrauterine transmission does not seem to be reduced by initiating antiretroviral therapy early in pregnancy.…”

Section: Discussionsupporting

confidence: 80%

“…Despite the fact that most guidelines for antiretroviral therapy in pregnancy recommend it [14,15], the available evidence does not indicate that prophylactic antiretroviral therapy initiated by week 14 of gestation affords more protection than that initiated at week 28 [13,16]. On the other hand, it has been demonstrated that zidovudine monotherapy started after 34 weeks of gestation has no impact on intrauterine MTCT [13,17].…”

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confidence: 99%

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HIV-1 viremia during the first 28 weeks of pregnancy is not associated with mother-to-child transmission

Senise¹,

Palácios²,

Tanno³

et al. 2006

Braz J Infect Dis

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It is currently recommended that antiretroviral prophylaxis to prevent mother-to-child transmission (MTCT) of HIV be initiated at 14 weeks of gestation. However, the relevance of early-gestation HIV viral load level for intrauterine MTCT is unknown. The objective of this study was to determine the relationship between prenatal maternal viral load and intrauterine MTCT. Records of HIV-infected pregnant women in two centers in Brazil, from 1999 to 2004 were analyzed. Three pregnancy periods were considered: earlier than 14 weeks, 14 to 27 6/7 weeks, and 28 weeks of gestation or more. Peripartum HIV exposure was also computed. Maximum viral load in each period was the measure of HIV exposure. Four hundred fifty-seven HIV-infected pregnant women were evaluated, but 53 were excluded. The MTCT rate was 0.49% (2/404-95% confidence interval (CI95) = 0.14-1.79%). Newborns were not breast-fed. Median viral load for the earlier-than-14-week period was 9,900 copies/mL (P25-75 1,000-50,775 copies/mL), 8,350 copies/mL (P25-75 707-42,000 copies/mL) for the 14 to 27 6/7-week period, and 435 copies/mL (P25-75 90-7,775 copies/mL) after the 28-week period. The peripartum median viral load was 400 copies/mL (P25-75 80-500 copies/mL). MTCT in mothers with VL > 1,000 copies/mL during the first 14 weeks (0.67%, 2/298) was not different from those with VL =1,000 copies/mL (0.0%, 0/96, P=1). Analogously, in the 14 to 27 6/7-week period, MTCT was similar in groups with VL higher (0.68%, 2/292) or lower (0%, 0/106) than 1,000 copies/mL (P=1). Regarding VL >1,000 copies/mL at 28-weeks-or-later and at peripartum periods, MTCT rates were 1.15% (2/173, P = 0.18) and 2.8% (2/71, P = 0.03), respectively. Intrauterine transmission does not seem to be influenced by HIV viremia during the first 28 weeks of pregnancy.

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Section: Discussionsupporting

confidence: 80%

mentioning

confidence: 99%

HIV-1 viremia during the first 28 weeks of pregnancy is not associated with mother-to-child transmission

Senise¹,

Palácios²,

Tanno³

et al. 2006

Braz J Infect Dis

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“…Positivity at birth denotes a positive test result within three days after birth. 2,5,[17][18][19][20][21] In addition, the nevirapine-nevirapine regimen was somewhat superior to the nevirapine-placebo regimen in most subgroups. Plus-minus values are means ±SE.…”

Section: Effect Of Nevirapine According To Known Risk Factors For Tramentioning

confidence: 99%

Single-Dose Perinatal Nevirapine plus Standard Zidovudine to Prevent Mother-to-Child Transmission of HIV-1 in Thailand

Lallemant

Jourdain

Cœur³

et al. 2004

N Engl J Med

386

204

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“…In women receiving ZDV, the relationship was markedly attenuated and no longer statistically significant (52). An HIV-1 RNA threshold below which there was no risk for transmission was not identified; ZDV was effective in reducing transmission regardless of maternal HIV-1 RNA copy number (52,77).…”

Section: Perinatal Hiv-1 Transmission and Maternal Hiv-1 Rna Copy Numbermentioning

confidence: 91%

U.S. Public Health Service Task Force Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions To Reduce Perinatal HIV-1 Transmission in the United States

Mofenson¹

2002

PsycEXTRA Dataset

153

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These recommendations update the February 4, 2002, guidelines developed by the Public Health Service for the use of zidovudine (ZDV) to reduce the risk for perinatal human immunodeficiency virus type 1 (HIV-1) transmission. This report provides healthcare providers with information for discussion with HIV-1-infected pregnant women to enable such women to make an informed decision regarding the use of antiretroviral drugs during pregnancy and use of elective cesarean delivery to reduce perinatal HIV-1 transmission. Various circumstances that commonly occur in clinical practice are presented, and the factors influencing treatment considerations are highlighted in this report. The Perinatal HIV Guidelines Working Group recognizes that strategies to prevent perinatal transmission and concepts related to management of HIV disease in pregnant women are rapidly evolving and will continually review new data and provide regular updates to the guidelines. The most recent information is available from the HIV/AIDS Treatment Information Service (available at http://www.hivatis.org). In February 1994, the results of Pediatric AIDS Clinical Trials Group (PACTG) Protocol 076 documented that ZDV chemoprophylaxis could reduce perinatal HIV-1 transmission by nearly 70%. Epidemiologic data have since confirmed the efficacy of ZDV for reduction of perinatal transmission and have extended this efficacy to children of women with advanced disease, low CD4 + T-lymphocyte counts, and prior ZDV therapy. Additionally, substantial advances have been made in the understanding of the pathogenesis of HIV-1 infection and in the treatment and monitoring of persons with HIV-1 disease. These advances have resulted in changes in standard antiretroviral therapy for HIV-1-infected adults. More aggressive combination drug regimens that maximally suppress viral replication are now recommended. Although considerations associated with pregnancy may affect decisions regarding timing and choice of therapy, pregnancy is not a reason to defer standard therapy. Use of antiretroviral drugs in pregnancy requires unique considerations, including the possible need to alter dosage as a result of physiologic changes associated with pregnancy, the potential for adverse short-or long-term effects on the fetus and newborn, and the effectiveness of the drugs in reducing the risk for perinatal transmission. Data to address many of these considerations are not yet available. Therefore, offering antiretroviral therapy to HIV-1-infected women during pregnancy, whether primarily for HIV-1 infection, for reduction of perinatal transmission, or for both purposes, should be accompanied by a discussion of the known and unknown short-and longterm benefits and risks of such therapy to infected women and their infants. Standard antiretroviral therapy should be discussed with and offered to HIV-1-infected pregnant women. Additionally, to prevent perinatal transmission, ZDV chemoprophylaxis should be incorporated into the antiretroviral regimen. regimen of zidovudine (ZDV) could red...

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Effect of zidovudine on perinatal HIV-1 transmission and maternal viral load

Cited by 23 publications

References 5 publications

HIV-1 viremia during the first 28 weeks of pregnancy is not associated with mother-to-child transmission

HIV-1 viremia during the first 28 weeks of pregnancy is not associated with mother-to-child transmission

Single-Dose Perinatal Nevirapine plus Standard Zidovudine to Prevent Mother-to-Child Transmission of HIV-1 in Thailand

U.S. Public Health Service Task Force Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions To Reduce Perinatal HIV-1 Transmission in the United States

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