Summary
The recently published Protocol 076 study (ACTG 076/ANRS 024) showed that zidovudine significantly decreased the relative risk of maternal HIV transmission by 71.5% compared with placebo. Oral zidovudine 100mg five times daily until the onset of labour, followed by intravenous zidovudine 2 mg/kg over 1 hour then 1 mg/kg • h until delivery, or an identical placebo regimen were administered to HIV-infected pregnant women (14 to 34 weeks’ gestation) with CD4+ counts > 200 cells/μl. 400 babies born to these women received zidovudine syrup 2 mg/kg or placebo administered 6-hourly for 6 weeks. The zidovudine regimens were well tolerated by both mothers and infants.
Further studies should aim to determine the mechanism by which zidovudine reduces the risk of maternal HIV transmission, the timing of HIV transmission, the efficacy of zidovudine in women not meeting the entry criteria for Protocol 076 and the long term effects of zidovudine during pregnancy on both mother and infant, and should examine the possibility of developing a simplified zidovudine regimen.
Following recent guidelines from the US and French public health services, the full Protocol 076 regimen should be given to all women fulfilling that study’s entry criteria. This regimen should also be considered in women with more severe disease or in later stages of gestation. Clinical efficacy of zidovudine should be monitored closely in women and infants, who should also be followed up for long term adverse effects.
Unblinded screening for HIV in pregnant women in the USA is facing extreme opposition; nevertheless, guidelines on HIV counselling and HIV testing of pregnant women are currently being developed there in light of the Protocol 076 findings.
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References
Allen S, Lindan C, Serufilira A, et al. Human immunodeficiency virus infection in urban Rwanda. JAMA 1991; 266(12): 1657–63.
Peckham CS. Mother-to-child transmission of HIV: risk factors and timing. IXth International Conference on AIDS; 1993 June 6–11; Berlin.
Davis S, Gwinn M, Wasser S, et al. HIV prevalence among US childbearing women, 1989–1992 [abstract no. 27]. 1st National Conference on Human Retroviruses; 1993 Dec 12–16; Washington DC..
Mofenson L. Epidemiology and determinants of vertical HIV transmission. Semin Pediatr Infect Dis 1994; 5: 252–65.
Anon. Working towards a European strategy for intervention to reduce vertical transmission of HIV. B J Obstet Gynaecol 1994; 101: 192–6.
Anon. The current global situation of the HIV/AIDS pandemic. Wkly Epidemiol Rec 1994; 26(1): 191–2.
Newell ML, Peckham C. Risk factors for vertical transmission of HIV-1 and early markers of HIV-1 infection in children. AIDS 1993; 7 Suppl. 1: S91–7.
Centres for Disease Control and Prevention. HIV/AIDS surveillance report. 1994 April
Weiser B. Quantitation of human immunodeficiency virus type 1 during pregnancy: relationship of viral titer to mother-to-child transmission and stability of viral load. Proc Natl Acad Sci U S A 1994; 91: 8037–41.
Connor EM, Sperling RS, Gelber R, et al. Reduction of human immunodeficiency virus type 1 with zidovudine treatment. N Engl J Med 1994; 331(18): 1173–80.
Rogers MF, Jaffe HW. Reducing the risk of maternal-infant transmission of HIV: a door is opened. N Engl J Med 1994; 331(18): 1222–3.
Rouzioux C, Costagliola D, Burgard M, et al. Timing of mother-to-child HIV-1 transmission depends on maternal status. AIDS 1993; 7 Suppl. 2: S49–52.
Burgard M, Mayaux M-J, Blanche S, et al. The use of viral culture and p24 antigen testing to diagnose human immunodeficiency virus infection in neonates. N Engl J Med 1992; 327: 1192–7.
Rouzioux C, Burgard M, Blanche S, et al. Quantitative PCR for the diagnosis of HIV-1 infection in newborns to seropositive mothers. In: Andrieu JM, editor. Viral quantitation in HIV infection. Paris: John Libbey Eurotext, 1991: 187–91.
Mofenson LM, Wolinsky SM. Vertical transmission of HIV. Part C: Current insights regarding vertical transmission. In: Pizzo PA, Wilfert CM, editors. Pediatric AIDS: the challenge of HIV infection in infants, children, and adolescents. Baltimore: Williams & Wilkins, 1994: 179–203.
De Rossi A, Ometto L, Mammano F, et al. Time course of antigenaemia and seroconversion in infants with vertically acquired HIV-1 infection. AIDS 1993; 7: 1528–9.
Goedert JJ, Duliège A-M, Amos CL, et al. High risk of HIV-1 infection for first-born twins. Lancet 1991; 338: 1471–5.
Bryson YJ, Luzuriaga K, Sullivan JL, et al. Proposed definitions for in utero versus intrapartum transmission of HIV-1. N Engl J Med 1992; 327(17): 1246–7.
Krivine A, Firtion G, Cao L, et al. HIV replication during the first few weeks of life. Lancet 1992; 239: 1187–9.
Anon. Early diagnosis of HIV infection in infants. J Acquir Immune Defic Syndr 1992; 5: 1169–78.
Mayaux MJ, Blanche S, Rouzioux C, et al. Maternal factors associated with perinatal HIV-1 transmission: The French Cohort Study; 7 years of follow-up. J Acquir Immune Defic Syndr. In press
Anon. Zidovudine for mother, fetus, and child: hope or poison? Lancet 1994; 344: 207–9.
Wilde MI, Langtry HD. Zidovudine: an update of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy. Drugs 1993; 46(3): 515–78.
Bayer R. Ethical challenges posed by zidovudine treatment to reduce vertical transmission of HIV. N Engl J Med 1994; 331(18): 1223–5.
Anon. Recommendations of the US Public Health Service Task Force on the use of zidovudine to reduce perinatal transmission of human immunodeficiency virus. MMWR Morb Mort Wkly Rep 1994; 43: 1–20.
HIV Infection in Newborns French Collaborative Study Group. Comparison of vertical human immunodeficiency virus type 2 and human immunodeficiency virus type 1 transmission in the French prospective cohort. Pediatr Infect Dis J 1994; 13: 502–6.
Blanche S, Rouzioux C, Guihard Moscato M-L, et al. A prospective study of infants born to women seropositive for human immunodeficiency virus type 1. N Engl J Med 1989; 320: 1643–8.
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Rouzioux, C. Prevention of Maternal HIV Transmission. Drugs 49 (Suppl 1), 17–24 (1995). https://doi.org/10.2165/00003495-199500491-00006
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DOI: https://doi.org/10.2165/00003495-199500491-00006