title: Oral zidovudine during labor to prevent perinatal HIV transmission, Bangkok: tolerance and zidovudine concentration in cord blood. Bangkok Collaborative Perinatal HIV Transmission Study Group.
abstract: OBJECTIVE
  To evaluate tolerance for the oral administration of zidovudine (ZDV) during labor and measure the resulting ZDV concentrations in umbilical cord blood.
  
  
  METHODS
  A cross-sectional study of women in a placebo-controlled trial of short-course ZDV (twice a day from 36 weeks' gestation until labor and every 3 h during labor) to prevent perinatal HIV transmission in Bangkok.
  
  
  METHODS
  Umbilical cord blood was collected. Sixty control specimens and specimens from 372 women (182 in the ZDV group, 190 in the placebo group) were tested for ZDV by radioimmunoassay (lower detection limit < 1 ng/ml).
  
  
  RESULTS
  All women in the ZDV group took one or more labor dose, 170 (93%) took their last dose within 3 h of delivery, and only five (3%) experienced nausea or vomiting, a proportion similar to the placebo group. The median concentration of ZDV in the cord blood in the ZDV group was 252 ng/ml (range, < 1-1133 ng/ml); 31 (17%) specimens were less than 130 ng/ml (0.5 microM), the concentration thought to be active against HIV in vitro. Median concentrations were 189 ng/ml in specimens from women taking one or two labor doses, 290 ng/ml in those taking three or four doses, and 293 ng/ml in those taking more than four doses (P < 0.01). The ZDV concentration was not associated with time since the last dose, body weight, or perinatal transmission.
  
  
  CONCLUSIONS
  Oral intrapartum ZDV was feasible and well tolerated. Most ZDV concentrations in the cord blood after oral dosing during labor were at therapeutic concentrations but were lower than those reported after continuous intravenous administration. Although concentrations were not associated with perinatal transmission, these data do not exclude the possibility that intrapartum and neonatal chemoprophylaxis is effective.
authors.affiliation: Siriraj Hospital Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand.
authors.forename: C
authors.initials: C
authors.lastname: Bhadrakom
authors.forename: R J
authors.initials: RJ
authors.lastname: Simonds
authors.forename: J V
authors.initials: JV
authors.lastname: Mei
authors.forename: S
authors.initials: S
authors.lastname: Asavapiriyanont
authors.forename: V
authors.initials: V
authors.lastname: Sangtaweesin
authors.forename: N
authors.initials: N
authors.lastname: Vanprapar
authors.forename: K H
authors.initials: KH
authors.lastname: Moore
authors.forename: N L
authors.initials: NL
authors.lastname: Young
authors.forename: W H
authors.initials: WH
authors.lastname: Hannon
authors.forename: T D
authors.initials: TD
authors.lastname: Mastro
authors.forename: N
authors.initials: N
authors.lastname: Shaffer
mesh_terms: D000284:Administration, Oral; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D005312:Fetal Blood; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007743:Labor, Obstetric / Q000097:blood*; D009325:Nausea / Q000139:chemically induced; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D011863:Radioimmunoassay; D013785:Thailand; D019562:Viral Load; D014839:Vomiting / Q000139:chemically induced; D015215:Zidovudine / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*
chemical_list: D019380:Anti-HIV Agents; D015215:Zidovudine