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Zidovudine + Lamivudine = Less Perinatal HIV Transmission

Continuing reductions in HIV perinatal transmission are attributable to public health efforts to identify and treat HIV-positive pregnant women. Since zidovudine was shown to be safe and effective in reducing perinatal transmission, more potent antiretroviral regimens have been widely applied in industrialized countries. In this report, outcomes in a large French observational cohort of 445 pregnant women and their offspring who received zidovudine plus lamivudine (3TC) during 1997 and 1998 were compared with a historical control group who received zidovudine alone from 1994 to 1997.

Among mother-infant pairs receiving zidovudine+3TC, HIV was transmitted to just 7 of 437 infants (1.6 percent). This rate was 4-fold lower than that observed in mother-infant pairs who received zidovudine monotherapy. Among these 7 cases, 3 mothers had an HIV RNA level below 500 copies/mL at delivery. Caesarean section was not associated with a reduced incidence of transmission. Resistance to 3TC was detected in about one third of women 6 weeks after delivery; it was much more common in women who continued zidovudine+3TC after delivery. Neutropenia and anemia were common among infants, and 2 HIV-negative children developed neurologic complications consistent with mitochondrial dysfunction, leading to death at approximately 1 year of age.

Comment: The reduced transmission rates achieved by potent antiretroviral regimens are cause for celebration. Although the 2 cases of mitochondrial toxicity are notable, larger studies have provided reassurance that these events are rare. More individualized approaches to treating pregnant women will be needed to address the effects of prior therapy, long-term therapy options for mothers, and potential toxicity to uninfected infants.

— D Havlir

Published in Journal Watch Infectious Diseases May 25, 2001

Citation(s):

Mandelbrot L et al. Lamivudine-zidovudine combination for prevention of maternal-infant transmission of HIV-1. JAMA 2001 Apr 25 285 2083-2093.

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