ZIDOVUDINE USE TO REDUCE PERINATAL HIV TYPE-1 TRANSMISSION IN AN URBAN MEDICAL-CENTER

Objective:-To evaluate whether zidovudine treatment was accepted and u sed by pregnant women subsequent to the release of the results of a mu lticenter, randomized, placebo-controlled trial (AIDS Clinical Trial G roup [ACTG] Protocol 076) that showed that zidovudine significantly re duced maternal-infant human immunodeficiency virus (HIV) type 1 transm ission. Design.-Prospective study. Setting:-A community hospital with an integrated, multidisciplinary HIV-dedicated program located in an i mpoverished, HIV-endemic urban setting. Participants.-All HIV-infected pregnant women identified after the release of the ACTG 076 results w ho were offered zidovudine therapy to reduce maternal-infant transmiss ion. Results.-Only 49 of the 125 HIV-infected pregnant women deliverin g at our site during this study period were identified prenatally. Per inatal zidovudine therapy was chosen by 37 (75%) of 49 women. Women re fusing zidovudine were more likely to report injection drug use as the ir HIV risk factor and to continue to use drugs during their pregnancy . Of women choosing zidovudine and delivering, 24 of 36 received all c omponents of their elected therapy. The intrapartum dose was missed by 12 women, 4 of whom also missed their prescribed prenatal oral therap y. Lack of adherence to chosen therapy was associated with continued c ocaine use during pregnancy. Conclusions.-Zidovudine therapy to interr upt vertical transmission of HIV was not widely used by these HIV-infe cted pregnant women. Further studies evaluating factors affecting the acceptance and use of recently published public health recommendations are needed.