University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

Question

• In a pregnant woman with known HIV infection, what are the best known courses of treatment with zidovudine (AZT) to reduce the likelihood of perinatal HIV (vertical) transmission to the infant?

Clinical Bottom Lines

1. Treatment of mothers with zidovudine (AZT) from 28 wks gestation to delivery and newborns for the first 3 days of life is equivalent in reducing vertical HIV transmission to treatment with zidovudine (AZT) from 28 wks gestation to delivery and newborns for the first 6 weeks of life.¹ 
2. Similarly, treatment of mothers with zidovudine (AZT) from 35 wks gestation to delivery tation and newborns for the first 6 weeks of life is equivalent in reducing vertical HIV transmission to treatment with zidovudine (AZT) from 28 wks gestation to delivery and newborns for the first 6 weeks of life.¹ 
3. In each of the above courses of treatment, both PO and IV zidovudine at the time of the delivery are acceptable if PO is tolerated.¹ 
4. Treatment with BID vs 5 times per day zidovudine did not make a significant difference in vertical transmission rates in the reference group vs. the previous Protocol 076 group.^1,2

Summary of Key Evidence

1. Babies HIV positive at 6 months following treatment of HIV positive mothers with zidovudine (AZT) from 28 wks gestation to delivery and the newborns for the first 3 days of life occurred at a rate of 4.7% vs. a rate of 6.5% using treatment with zidovudine (AZT) from 28 wks gestation to delivery and newborns for the first 6 weeks of life (p value 0.86).¹
2. Also insignificant was the rate of Babies HIV positive at 6 months following treatment of HIV positive mothers with zidovudine (AZT) from 28 wks gestation to delivery and the newborns for the first 3 days of life at a rate of 8.6% vs. a rate of 6.5% using treatment with zidovudine (AZT) from 28 wks gestation to delivery and newborns for the first 6 weeks of life (p value 0.15).

Additional Comments

• A short course of zidovudine in mother and baby (starting @ 35 wks gestation to delivery and infant for only the 1st 3 days of life) resulted in rate of transmission of 10.5% which was significantly different (p 0.004) than the reference group (4.1% rate) where treatment with zidovudine (AZT) was from 28 wks gestation to delivery and newborns for the first 6 weeks of life.¹
• In both US and world health systems the difference in shortening the duration of treatment for infants may reduce both cost and adverse affects while reducing compliance problems. 

   

Citation

1. Lallemant M et al. A trial of shortened zidovudine regimens to prevent mother-to-child transmission of human immunodeficiency virus type 1. N Engl J Med 2000;343:982-91. 
2. Coonor EM, Sperling RS, Gelber R et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. N Engl J Med 1994;331:1173-80. 

CAT Author: Patrick Seed, MD, PhD

CAT Appraisers: John G. Frohna, MD

Date appraised: October 23, 2000