ACCEPTABILITY AND IMPACT OF ZIDOVUDINE FOR PREVENTION OF MOTHER-TO-CHILD HUMAN IMMUNODEFICIENCY VIRUS-1 TRANSMISSION IN FRANCE

We studied the propagation and the impact of zidovudine prevention on the human immunodeficiency virus-1 transmission rate from infected mot hers to their infants in the French nationwide prospective cohort. inf ection was diagnosed in the children on the basis of at least two posi tive human immunodeficiency virus-1 polymerase chain reaction tests, c ulture, or both. The transmission rate among treated women was compare d with that among untreated women during the same period and with that among women enrolled in the cohort since 1986. The impact of zidovudi ne was analyzed according to the women's clinical and biologic charact eristics, the mode of delivery, and use of zidovudine therapy before t he pregnancy. Nearly 90% of women were treated as soon as the second h alf of 1994. In 1994 and 1995, 80% of mother-child pairs received at l east one of the three phases of preventive treatment, Among the 663 mo thers enrolled during these 2 years, only six refused the treatment. Z idovudine treatment was associated with a reduction in the transmissio n rate of nearly two-thirds, from 14% +/- 6% to 5% +/- 2% (p <0.01). T he degree of reduction was not influenced by the maternal CD4(+) cell count of p24 antigenemia at delivery. Zidovudine treatment of the moth er before the pregnancy considerably reduced the impact of preventive therapy; the transmission rate was significantly higher among pretreat ed mothers (20% versus 5%, p <0.01) even after adjusting for maternal CD4(+) cell count. Zidovudine prevention is now widely used in France and has had a major impact on the epidemiology of mother-child human i mmunodeficiency virus transmission. This justifies a policy of offerin g human immunodeficiency virus screening to all women before or shortl y after the diagnosis of pregnancy.