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Prevention of vertical HIV transmission: additive protective effect of elective Cesarean section and zidovudine prophylaxis

Kind, Christian1,10; Rudin, Christoph2; Siegrist, Claire-Anne3; Wyler, Claire-Anne3; Biedermann, Kurt4; Lauper, Urs5; Irion, Olivier6; Schüpbach, Jörg7; Nadal, David8; Swiss Neonatal HIV Study Group

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Abstract

Objective: To study the effect of elective Cesarean section and zidovudine prophylaxis on vertical HIV transmission.

Design: Prospective study.

Setting: Obstetric and paediatric clinics in Switzerland.

Participants: Children of mothers with HIV infection identified before or at delivery.

Interventions: Routine use of elective Cesarean section for HIV-infected parturients by some Swiss centres since 1985. National recommendation for zidovudine prophylaxis in mid-1994.

Main outcome measure: HIV infection status of children.

Results: In a cohort of 494 children born at least 6 months before the analysis date, 67 out of 414 children with known infection status were found to be infected, giving an overall transmission rate of 16.2% [95% confidence interval (CI), 13.0–18.5]. Elective Cesarean section with intact membranes and without previous labour was associated with a lower transmission rate of 6% [odds ratio (OR), 0.29; 95% CI, 0.12–0.70; P = 0.006 versus other delivery modes]. Transmission rate was intermediate after spontaneous delivery or non-elective Cesarean section (18%), and higher after obstetric interventions (27%; test for trend, P < 0.001). Since mid-1994, 78% of all women with registered pregnancies have received some form of zidovudine prophylaxis. Transmission rate was reduced from 17 to 7% after any zidovudine exposure (OR, 0.4; 95% CI, 0.11–1.41). Combined use of elective Cesarean section and zidovudine resulted in a 0% transmission rate (none out of 31), compared with 8% (seven out of 86) after elective Cesarean section without zidovudine, 17% (four out of 24) after zidovudine alone, and 20% (55 out of 271) after no intervention.

Conclusions: Elective Cesarean section and zidovudine prophylaxis appear to have an additive effect in the prevention of vertical HIV transmission.

© Lippincott-Raven Publishers.

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