title: Is intrapartum intravenous zidovudine for prevention of mother-to-child HIV-1 transmission still useful in the combination antiretroviral therapy era?
abstract: 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 <400 copies/mL, there was no difference in MTCT rate (0% without intravenous ZDV vs 0.6% with intravenous ZDV; P = .17). Intravenous ZDV was not associated with increased short-term hematological toxicity or lactate level.
  
  
  CONCLUSIONS
  Intravenous ZDV remains an effective tool to reduce transmission in cases of virological failure, even in cART-treated women. However, for the vast majority of women with low viral loads at delivery, in the absence of obstetrical risk factors, systematic intravenous ZDV appears to be unnecessary.
authors.affiliation: INSERM U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Sud, Paris, France. nelly.briand@inserm.fr
authors.forename: Nelly
authors.initials: N
authors.lastname: Briand
authors.forename: Josiane
authors.initials: J
authors.lastname: Warszawski
authors.forename: Laurent
authors.initials: L
authors.lastname: Mandelbrot
authors.forename: Catherine
authors.initials: C
authors.lastname: Dollfus
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Pannier
authors.forename: Ludovic
authors.initials: L
authors.lastname: Cravello
authors.forename: Rose
authors.initials: R
authors.lastname: Nguyen
authors.forename: Isabelle
authors.initials: I
authors.lastname: Matheron
authors.forename: Norbert
authors.initials: N
authors.lastname: Winer
authors.forename: Roland
authors.initials: R
authors.lastname: Tubiana
authors.forename: Christine
authors.initials: C
authors.lastname: Rouzioux
authors.forename: Albert
authors.initials: A
authors.lastname: Faye
authors.forename: Stéphane
authors.initials: S
authors.lastname: Blanche
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D016009:Chi-Square Distribution; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control* / Q000706:statistics & numerical data; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies; D012307:Risk Factors; D019562:Viral Load; D015215:Zidovudine / Q000627:therapeutic use*
chemical_list: D019380:Anti-HIV Agents; D015215:Zidovudine
keywords: intrapartum prophylaxis; mother-to-child HIV transmission; pregnancy; toxicity; zidovudine