THERAPEUTIC AND OTHER INTERVENTIONS TO REDUCE THE RISK OF MOTHER-TO-CHILD TRANSMISSION OF HIV-1 IN EUROPE

Objectives To document policies regarding the use of interventions to reduce risk of vertical transmission of human immunodeficiency virus ( HIV) and assess the extent of changes since 1994. Design A postal ques tionnaire survey and data from the European Collaborative Study (ECS), a prospective multi-centre cohort study. Setting Fifty-four obstetric centres in 16 European countries. Sample A questionnaire response fro m 54 obstetricians; 669 deliveries to HIV-infected women enrolled in t he ECS from 1994 to 1997. Main outcome measures Use of zidovudine duri ng pregnancy, at delivery and to the neonate; caesarean section delive ry rates; vaginal lavage; avoidance of breastfeeding; vertical transmi ssion rate. Results Zidovudine therapy to reduce vertical transmission is now widespread in Europe and routine in all but one centre surveye d, although regimens vary. In 11 (26%) centres elective caesarean sect ion is offered to all HIV-infected women and a further nine (21%) have a policy of routine vaginal lavage. In all centres HIV-infected women are advised to avoid breastfeeding. In the ECS there has been a signi ficant temporal decline in the vertical transmission rate with an incr ease in zidovudine use. More than 90% of women in the ECS who were del ivered in 1997 received one or more components of zidovudine therapy; the rate of vertical transmission is 9% where zidovudine has been used , compared with 15% without use of zidovudine. Conclusions Although th e use of zidovudine to reduce vertical transmission is increasing in E urope and, with the avoidance of breastfeeding, is associated with a d ecline in vertical transmission, the success of these interventions wi ll be limited by the uptake of antenatal screening.