Is Intrapartum Intravenous Zidovudine for Prevention of Mother-to-Child HIV-1 Transmission Still Useful in the Combination Antiretroviral Therapy Era?

• Published in: Clinical infectious diseases 2013-09, Vol.57 (6), p.903-914
• Main Authors: Briand, Nelly, Warszawski, Josiane, Mandelbrot, Laurent, Dollfus, Catherine, Pannier, Emmanuelle, Cravello, Ludovic, Nguyen, Rose, Matheron, Isabelle, Winer, Norbert, Tubiana, Roland, Rouzioux, Christine, Faye, Albert, Blanche, Stéphane
• Format: Article
• Language: English
• Subjects: Adult; Anti-HIV Agents - therapeutic use; Antibiotic Prophylaxis; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral drugs; Antiretrovirals; Antiviral agents; Assisted reproductive techniques; Biological and medical sciences; Carts; Cesarean section; Chi-Square Distribution; Disease transmission; Drug therapy; Female; HIV; HIV 1; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - prevention & control; HIV Infections - transmission; HIV/AIDS; Human immunodeficiency virus; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunology; Immunopathology; Infant, Newborn; Infants; Infectious Disease Transmission, Vertical - prevention & control; Infectious Disease Transmission, Vertical - statistics & numerical data; Infectious diseases; Male; Maternal & child health; Medical sciences; Pharmacology. Drug treatments; Pregnancy; Pregnancy Complications, Infectious - drug therapy; Pregnancy Complications, Infectious - epidemiology; Pregnancy Complications, Infectious - prevention & control; Prospective Studies; Risk Factors; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral Load; Virology; Zidovudine - therapeutic use
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/cit374

Background. Intrapartum intravenous zidovudine (ZDV) prophylaxis is a long-standing component of prevention of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) in high-resource countries. In some recent guidelines, intravenous ZDV is no longer systematically recommended for mothers receiving combination antiretroviral therapy (cART) with low viral load. We evaluated the impact of intravenous ZDV according to viral load and obstetrical conditions. Methods. All HIV-1—infected women delivering between 1 January 1997 and 31 December 2010 in the French Perinatal Cohort (ANRS-EPF) were analyzed if they received ART during pregnancy and did not breastfeed. We identified maternal and obstetrical characteristics related to lack of intravenous ZDV and compared its association with MTCT rate and other infant parameters, according to various risk factors. Results. Intravenous ZDV was used in 95.2% of the 11 538 deliveries. Older age, multiparity, and preterm and vaginal delivery were associated with lack of intravenous ZDV (n = 554). In women who delivered with viral load ≥1000 copies/mL, the overall MTCT rate was higher without than with intravenous ZDV (7.5% vs 2.9%; P = .01); however, there was no such difference when the neonate received postnatal intensification therapy. Among them, 77% of women who had viral load