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Effect of Prenatal Zidovudine on Disease Progression in Perinatally HIV-1-Infected Infants

Souza Ricardo S. de; Gómez-Marín, Orlando; Scott, Gwendolyn B.; Guasti, Silvia; O'Sullivan, Mary Jo; Oliveira, Ricardo Hugo; Mitchell, Charles D.
JAIDS Journal of Acquired Immune Deficiency Syndromes: June 1st, 2000
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Objective:To determine the influence of prenatal zidovudine (ZDV) prophylaxis 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 were reviewed retrospectively. Participants were divided according to maternal ZDV use: no ZDV (n = 152); ZDV (n = 139). The main outcome measure was rapid disease progression (RPD) in the infant, defined as occurrence of a category C disease or AIDS-related death before 18 months of age.

Results:HIV vertical transmission rates were significantly different (no ZDV versus ZDV: 22.3% versus 12.2%; p = .034). Among infected infants, the RPD 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 infected infants born to HIV-infected mothers treated with ZDV than among infected infants born to untreated mothers. The decreased proportion of infected infants with nonrapid disease progression in the former group might be related to the ability of ZDV to block intrapartum transmission preferentially and also to nonrapid disease progression resulting from intrapartum transmission.

Address correspondence and reprint requests to Charles Mitchell, Division of Immunology and Infectious Diseases, Department of Pediatrics, University of Miami School of Medicine, 1550 Northwest 10th Avenue, Miami, FL 33136, U.S.A.

Manuscript received November 22, 1999; accepted March 9, 2000.

© 2000 Lippincott Williams & Wilkins, Inc.