(a) HIV diagnosis before and during pregnancy: antenatal antiretroviral therapy (ART) + intrapartum IV Zidovudine (ZDV
) + ZDV
syrup + formula for the newborn;
Editorial Note: The findings in this report indicate that a high proportion of health-care providers in Michigan are following PHS guidelines for maternal and neonatal ZDV
use to reduce perinatal HIV transmission.
An important preliminary finding in our study is that among women with CD4 cell counts <200/[micro]l, only 1 of 57 mothers on HAART (1.8%) transmitted HIV, as opposed to 26 (5.7%) of 453 mothers receiving ZDV
. Although this was not statistically significant, we expected more transmission among these mothers because of their low CD4 counts before initiation of HAART.
mother-infant pairs [studied.sup.ss] (mother tested before delivery) 323 395 320 % Offered prenatal ZDV
27% 69% 85% Range (22%-38%) (60%-97%) (67%-91%) % Offered intrapartum ZDV
5% 57% 75% Range (0-15%) (53%-74%) (53%-84%) % Offered neonatal ZDV
5% 70% 76% Range (0-16%) (64%-77%) (64%-82%) % Without prenatal care 15% 13% 12% Range (8%-24%) (5%-25%) (3%-27%) (*.)Pooled estimate and range among states.
Study outcome of perinatal zidovudine (ZDV
) trial, by treatment group -- Bangkok, Thailand, 1998
Documentation of the increasing use of ZDV
therapy among mothers following publication of PHS guidelines is consistent with other assessments noting the increased use of ZDV
by pregnant HIV-infected women and their newborns that was associated with reduced rates of perinatal transmission (6).
(b) Based on TCD4 cell count < 350 cells x 103/mL (c) ZDV
, zidovudine; 3TC, lamivudine; LPV/r, ritonavir-boosted lopinavir; NFV, nelfinavir; NVP, nevirapine.
These studies also will examine factors that may contribute to a change in perinatal HIV transmission rates (e.g., changing obstetrical practices and womens' attitudes toward and adherence to ZDV
and other preventive therapy).
(APH = antepartum haemorrhage; PPH = postpartum haemorrhage; sdNVP = single-dose nevirapine; cART = combination antiretroviral therapy; ZDV
In it zidovudine (ZDV
) plus lamivudine (3TC) were recommended as the preferred nucleoside reverse-transcriptase inhibitors (7,8).
Independent predictors of PI resistance were genotyping year of study, gender, CD4 count, previous ZDV
+ ddI dual therapy, unboosted PI, boosted PI, NNRTI, T20, RAL, and any PI in the last regimen.
Therapy was initiated after immunologic and viral loads were determined as per WHO criteria.13 A combination of the two nucleoside reverse transcriptase inhibitors (NRTI's), zidovudine (ZDV
) and lamivudine (3TC), plus either the non-nucleoside reverse transcriptase inhibitor (NNRTI) nevaripine or the protease inhibitor (PI) nelfinavir were initiated as per WHO criteria.