Disease progression and early viral dynamics in human immunodeficiency virus-infected children exposed to zidovudine during prenatal and perinatal periods

Zidovudine (Zdv) is widely used to reduce maternal-infant human immunodefic iency virus transmission (HIV), but its consequences for disease progressio n among children infected despite Zdv exposure remain unknown. In a multice nter observational cohort study of 325 HIV-infected children born during 19 86-1997, clinical progression was compared among infected children exposed or unexposed to Zdv during prenatal and perinatal periods. Zdv exposure was associated with 1.8-fold (95% confidence interval, 1.02-3.11) increased ri sk of progressing to AIDS or death after adjusting for year of birth, mater nal CD4 cell count, maternal AIDS diagnosis, and subsequent antiretroviral therapy of the child. Mean log(10) viral copies at 7-12 weeks were higher a mong Zdv-exposed children (P = .004). No infected child treated early with multidrug therapy progressed to AIDS or died by 1 year, regardless of early Zdv exposure. More rapid disease progression was observed among infected c hildren exposed during pregnancy or birth to Zdv if effective multidrug the rapy was not initiated.