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Risk factors for perinatal human immunodeficiency virus transmission in patients receiving zidovudine prophylaxis.

D E Shapiro1, R S Sperling, L Mandelbrot

  • 1Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts 02115-6017, USA. shapiro@sdac.harvard.edu

Obstetrics and Gynecology
|November 27, 1999
PubMed

Insights

High maternal weight and exposure to maternal blood during pregnancy can reduce the effectiveness of zidovudine (AZT) for preventing mother-to-child HIV transmission. These factors may diminish the protective benefits of AZT chemoprophylaxis.

Area of Science:

  • Obstetrics
  • Infectious Diseases
  • Virology

Background:

  • Perinatal human immunodeficiency virus type 1 (HIV-1) transmission is a significant concern.
  • Zidovudine (AZT) chemoprophylaxis has been proven effective in preventing mother-to-child HIV-1 transmission.
  • Identifying factors that compromise AZT efficacy is crucial for optimizing prevention strategies.

Purpose of the Study:

  • To identify modifiable obstetric factors associated with the failure of zidovudine (AZT) chemoprophylaxis.
  • To determine if antepartum or intrapartum risk factors influence the effectiveness of AZT in preventing perinatal HIV-1 transmission.

Main Methods:

  • Analysis of data from the Pediatric AIDS Clinical Trials Group protocol 076, a randomized, double-masked, placebo-controlled trial.
  • Estimation of the zidovudine treatment effect using relative reduction in transmission risk.
  • Univariate and multivariate statistical analyses to assess the impact of potential risk factors on treatment efficacy.

Main Results:

  • The zidovudine treatment effect varied significantly by maternal weight; heavier women (over 82 kg) had a lower relative reduction in transmission risk (26%) compared to lighter women (79%).
  • Women who transmitted HIV-1 in the zidovudine group were more likely to have undergone antepartum procedures or have conditions increasing fetal exposure to maternal blood (43% vs. 19%).
  • Multivariate analysis, including adjustments for HIV-1 RNA levels and CD4+ cell percentage, did not negate the differential treatment effect observed with these factors.

Conclusions:

  • High maternal weight may diminish the efficacy of zidovudine chemoprophylaxis in preventing perinatal HIV-1 transmission.
  • Conditions or procedures associated with increased fetal exposure to maternal blood or cervicovaginal secretions can reduce the effectiveness of zidovudine.
  • These findings highlight the importance of considering maternal weight and exposure risks when implementing AZT prophylaxis.
Abstract

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