An effective and safe protocol involving zidovudine and caesarean section to reduce vertical transmission of HIV-1 infection

Objective: To investigate zidovudine prophylaxis with caesarean section to reduce mother-to-infant HIV transmission. Interventions: Elective caesarean section before labour, usually at 36-38 w eeks of gestation, plus a short oral course of zidovudine, normally startin g at week 32, intravenous zidovudine before caesarean section and for 10 da ys for the neonate (the reduced Berlin regimen). Results: Of 179 mother-infant pairs 104 received no antiretroviral prophyla xis or therapy (control group), 48 received the reduced Berlin prophylaxis regimen, 18 received combination therapy and nine received only part of the prophylaxis regimen. Of the antiretroviral group, 68 were delivered by ele ctive caesarean section. The HIV transmission rate was zero in the antiretr oviral group [95% confidence interval (CI) 4.7] and 12.6% (6.4-19.0) in the control group. The reduction in vertical transmission was 90% for the Berl in regimen, with an 80 and 70% reduction in risk associated with antiretrov iral treatment and caesarean section, respectively. Maternal CD4 cell count but not viral load had some confounding effect on the reduction in risk at tributed to caesarean section and the prophylactic regimen. Neonatal haemat ological abnormalities associated with antiretroviral intervention lasted f or up to 7 weeks. Weight and length, although significantly lower at birth, were normal by 6-8 weeks. Conclusion: A much reduced three-arm regimen of zidovudine prophylaxis in c ombination with caesarean section before labour is highly effective in redu cing the risk of vertical HIV transmission and is safe for the infant, (C) 2000 Lippincott Williams & Wilkins.