Zidovudine and Perinatal Human Immunodeficiency Virus Type 1 Transmission: A Population-Based Approach

Abstract

ABSTRACT.Objective. This study examined the impact of the full 3-arm zidovudine regimen on the perinatal transmission of human immunodeficiency virus type 1 (HIV-1) using population-based data.Methods. We retrospectively ascertained information on zidovudine prescription and other characteristics of HIV-infected pregnant women and children for birth cohort years 1993, 1995, 1996, and 1997 using HIV/ acquired immunodeficiency syndrome registry data from a state health department supplemented by medical record reviews.Results. The transmission rate decreased from 12.5% in 1993 to 4.6% in 1997. The proportions of HIV-1-infected mothers and children who were prescribed all 3 arms of zidovudine increased from 68% in 1995 to 93% in 1997. T he connection between human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in children and mothers with AIDS or at risk for HIV was recognized in the early 1980s. 1 Since then, the number of AIDS cases among children has increased dramatically, and Ͼ90% of these cases among children have been acquired perinatally. 2 The transmission of HIV from mother to child has been estimated to occur in approximately 15% to 30% of children born to HIVinfected women in the United States. 1 Zidovudine is the first antiretroviral medication approved worldwide for the treatment of HIV/ AIDS. It is also the first drug to be used in a clinical trial of HIV-infected pregnant women to determine its efficacy in reducing perinatal HIV transmission. 3 This randomized trial-AIDS Clinical Trial Group 076 (ACTG 076)-demonstrated a reduction of perinatal HIV transmission with zidovudine by almost 70%. 3 Since the successful use of zidovudine in HIVinfected pregnant women in the ACTG 076, recommendations have been published for the use of zidovudine to reduce perinatal HIV infection. 4 In addition, other studies have demonstrated the success of zidovudine in reducing perinatal HIV transmission. 5-10 The US and European epidemiologic studies demonstrating striking decreases in the perinatal transmission of HIV from prophylactic (zidovudine) administration have used data from hospitals, public health clinics, and private physicians' offices. This study uses data from a population-based HIV/AIDS surveillance database from a state that has HIV infection reporting by name. The objective of this study was to explore the relationship between zidovudine prescription and perinatal HIV-1 transmission among mother-child pairs in which the mother is known before delivery to be infected with HIV. METHODSData were provided by the state health department for all mother-child pairs who had been reported to the HIV/AIDS surveillance registry, a population-based registry that contains all of the reported HIV-positive or AIDS cases in the state, for calendar years 1993, 1995, 1996, and 1997. Eligible cases included mother-child pairs in which the mother's first confirmed HIV-positive test preceded the birth of the child, prenatal care and delivery occurred in the state, and birth outcome resulted in a live...

Transplacentally exposed human and monkey newborn infants show similar evidence of nucleoside reverse transcriptase inhibitor‐induced mitochondrial toxicity

“…Maternal-fetal human immunodeficiency virus-1 (HIV-1) transmission has decreased rapidly during the past 10 years, largely due to nucleoside reverse transcriptase inhibitor (NRTI) therapy given during pregnancy and delivery [Harris et al, 2002;Cooper et al, 1996]. Zidovudine (AZT), the first NRTI recommended for this purpose, is now a frequent component of typical combination protocols that include two NRTIs and either a non-NRTI or a protease inhibitor [''Guidelines,'' 2005a;''Guidelines,'' Invited article on the genotoxicity of perinatal NRTI therapy.…”

Manejo de la infección materna con VIH y del recién nacido expuesto

“…No suministro de ZDV mediante el protocolo PACTG 076. 33 Los procedimientos diagnósticos prenatales "invasivos" están contraindicados, tales como amniocentesis, cordocentesis y biopsia de vellosidad corial.…”

Successes and Challenges in the Perinatal HIV-1 Epidemic in the United States as Illustrated by the HIV-1 Serosurvey of Childbearing Women

“…The second phase, spanning 1994 to 1996, followed publication of the results of Pediatric AIDS Clinical Trials Group protocol 076, demonstrating the efficacy of zidovudine prophylaxis in preventing transmission 3 ; during this period there was rapid and widespread implementation of the PACTG 076 antepartum/intrapartum/infant zidovudine prophylaxis regimen throughout the United States and other resource-rich countries, and decreases in MTCT rates to approximately 5% to 8% were observed by as early as 1995. [4][5][6] The third phase began around 1997, when combination antiretroviral regimens (primarily dual nucleoside analogue therapy) became more widely used by pregnant women, with a further decrease in MTCT rates to 3% to 4%. 7 The current phase began around 1999, when highly active antiretroviral therapy began to be more widely prescribed to pregnant women, and several studies were published that indicated that elective cesarean delivery reduced the risk of transmission 8,9 ; in 2001, highly active antiretroviral therapy and elective cesarean delivery were recommended by the US Public Health Service Task Force for all HIV-1-infected pregnant women with HIV-1 RNA levels greater than 1000 copies/mL.…”