Effect of prenatal zidovudine on disease progression in perinatally HIV-1-infected infants

Objective: To determine the influence of prenatal zidovudine (ZDV) prophyla xis on the course of HIV-1 infection in children by comparing the clinical outcome of infants born to HIV-1-seropositive mothers who did versus those who did not receive ZDV during pregnancy. Methods: Medical records of HIV-1-seropositive mothers and their infants we re reviewed retrospectively. Participants were divided according to materna l ZDV use: no ZDV (n = 152); ZDV (n = 139). The main outcome measure was ra pid disease progression (RPD) in the infant, defined as occurrence of a cat egory C disease or AIDS-related death before 18 months of age. Results: HIV vertical transmission rates were significantly different (no Z DV versus ZDV: 22.3% versus 12.2%; p = .034), Among infected infants, the R PD rate was 29.4% in the no ZDV group compared with 70.6% in the ZDV group (p = .012), and prematurity was significantly associated with a higher risk of RPD (p = .027). Conclusions: The rate of RPD was significantly higher among perinatally inf ected infants born to HIV-infected mothers treated with ZDV than among infe cted infants born to untreated mothers. The decreased proportion of infecte d infants with nonrapid disease progression in the former group might be re lated to the ability of ZDV to block intrapartum transmission preferentiall y and also to nonrapid disease progression resulting from intrapartum trans mission.