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Lancet. 1999 Mar 6;353(9155):766-7.

Short-course zidovudine for prevention of perinatal infection.

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  • 1Pediatric, Adolescent, and Maternal AIDS Branch, Center for Research for Mothers and Children, National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD 20852, USA.



In 1994, the Pediatric AIDS Clinical Trials Group (PACTG) protocol 076 showed that a 6-week course of zidovudine, given to the mother during pregnancy and labor, and then to the neonate for 6 weeks, reduced HIV transmission rates by almost 70%. The adoption of this regimen in the US and Europe has caused perinatal HIV transmission rates to decline to 6% or less, while transmission rates of 2% have been reported when zidovudine prophylaxis is combined with elective cesarean delivery. However, in absolute terms, the impact of perinatal HIV transmission prevention measures will be greater in developing than in industrialized countries, in part because the overall level of HIV infection among pregnant women in developing countries is far higher than the overall level in industrialized countries. While trials must continue to identify simpler and more cost-effective HIV prevention measures, effort must still be given to implementing the already proven effective regimens in developing countries. To implement short-course HIV prophylactic regimens requires available and accessible antenatal care, HIV testing and follow-up for pregnant women, available and affordable zidovudine, and patient compliance with the drug regimen. To ensure intrapartum zidovudine administration, deliveries must be attended by professional birth attendants. Then, to prevent postpartum HIV transmission, there must be a safe and effective strategy for reducing the risk of HIV-1 transmission through breast milk.

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