Maternal characteristics associated with antenatal, intrapartum, and neonatal zidovudine use in four US Cities, 1994-1998

Objectives: To evaluate implementation of 1994 United States Public Health Service guidelines for zidovudine (ZDV) use in HIV-infected women and their newborns by describing the prevalence of use of perinatal ZDV and other an tiretrovirals and by investigating determinants of not receiving perinatal ZDV. Design/Methods: The Perinatal AIDS Collaborative Transmission Study is a pr ospective cohort study designed to collect information related to mother-to -child HIV transmission that was conducted in New York City (NY), Newark (N J), Baltimore (MD), and Atlanta (GA), U.S.A. The current analysis was restr icted to infants born between July 1994 and June 1998. Results: Utilization rates for antenatal, intrapartum, and neonatal ZDV inc reased from 41% to 70% during the 4-year period. Use of combination antiret rovirals increased from fewer than 2% of women in 1994 to 1995 to 35% in 19 97 to 1998. Antenatal and neonatal ZDV use increased each year, but intrapa rtum ZDV use reached a plateau after 1996. Mother-infant pairs with the fol lowing characteristics were less likely to have received a complete 3-part ZDV regimen: older maternal age, CD4 count > 500 cells/mul, preterm birth, cocaine or heroin use during pregnancy, positive newborn drug screen test r esult, and smoking or alcohol use during pregnancy. By multivariate logisti c regression adjusted for hospital and year of birth, cocaine or heroin use during pregnancy (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.6- 3.3), maternal CD4 count (OR, 0.4; 95% CI, 0.2-0.8; comparing < 200 with > 500 cells/mul), and preterm birth (OR, 1.6; 95% CI, 1.1-2.5) remained indep endently associated with not receiving the complete ZDV regimen. Conclusions: ZDV use by pregnant HIV-infected women and their infants has i ncreased dramatically since publication of the 1994 guidelines. Nevertheles s, women who abuse substances, give birth preterm, or have less advanced im munosuppression, were at substantial risk of not receiving the complete ZDV regimen.