The Efficacy of 4-week Zidovudine in Mothers and Infants to Prevent perinatal HIV-1 Transmission

Abstract

The Efficacy of 4-week Zidovudine in Mothers and Infants to Prevent perinatal HIV-1 Transmission

Uraiwan             Tarunotai                         MD*

Pasuwat            Kongsin                            MD**

Piyaporn           Bowonkiratikachorn     MD***

Parade              Klinsukond                       MD****

Somchit             Verawat                           MD*****

Objective: To assess the efficacy of zidovudine (ZDV) for the prevention of maternal-infant HIV-1 transmission

Study design: Prospective descriptive study

Subjects: HIV infected pregnant women and their infants infants who were born in 3 Bangkok Metropolitan Administration (BMA) hospitals (BMA Medical college and  Vajira Hospital, Charoenkrung Pracharak Hospital and Taksin Hospital ) from August 1999.

Methods: Asymptomatic HIV infected pregnant women of gestational age less than 36 weeks were counseled not to breastfeed and tested for CBC and CD₄ lymphocyte count. Mothers received oral ZDV 300 mg twice a day for 36 week' gestation until onset of labor then every 3 hours until delivery. Infants received ZDV syrup 2mg/kg every 6 hours for +4 weeks and were tested for CBC at birth, 1 month and 3 months of age, then HIV-1 DNA PCR at 3 and 6 months or HIV antibody at the age of 12 and 18 months.

Main outcome measures: Infants were considered to be HIV infected by 2 persistent positive HIV-1 DNA PCR or a positive HIV- Ab test result in a child 18 months of age or older.

Results: Between August, 1997 and August, 1999, 260 asymptomatic HIV infected pregnant women delivered 264 live-born infants, including 256 singletons and 4 sets of twin. Of 232 infants with known HIV-infection status, there 16 infected infants. The estimated perinatal HIV-1 transmission risk was 6.9 %. We found that maternal age, hematocrit, CD₄lymphocyte count, duration of membrane rupture, mode of delivery, gestational age, gender and birth weight were not significantly associated with maternal to child transmission. Most infants tolerated ZDV very well. Minimal short-term toxic effects were observed. There were vomiting during ZDV taking, anemia and neutropenia then improved after discharging the drug.

Vajira Med J 2004 ; 48 : 47 - 55