Vertical HIV-1 transmission: prophylaxis and paediatric follow-up

To study the effectiveness of anti-HIV therapy for vertical HIV-1 transmission based on the PACTG protocol 076, modified and adapted to Venezuela.

Between March 1997 and March 2000, 74 HIV-1-infected women (15-42 years old) with 77 singleton pregnancies were evaluated. Zidovudine (ZDV) 500 mg/day (average 8 weeks) was begun after Western blot confirmatory tests, independent of CD4+ count or viral load. ZDV was administered as follows: 47 patients (61 per cent) received prenatal, perinatal and postnatal therapy; 13 (17 per cent) received prenatal and postnatal therapy; two (3 per cent) received prenatal and perinatal therapy; one patient received perinatal and postnatal therapy; seven (9 per cent) received only postnatal therapy. Seven HIV-1 infected women received no treatment. Thirty-two newborns were obtained by C-section (45.7 per cent), while 38 were delivered vaginally (54.2 per cent). Due to advanced maternal illness, seven HIV-1-infected women received ZDV+3TC, two women received ZDV+ddI and one woman received ZDV+3TC+ Ritonavir. Breastfeeding was avoided in all cases.

Outcomes showed 65 term newborns and five preterm newborns; three abortions; one fetal loss and one preterm death. Two maternal/fetal deaths were secondary to complications related to AIDS at 27 and 29 weeks, respectively. Twenty-one children over 18 months old were considered uninfected. Thirty-five infants below 15 months of age were considered with the status of indeterminate HIV-1 infection (PO). Three infants fewer than 5 months of age with multiple risk factors were considered infected (P2). Two infants were asymptomatic and HIV positive at 12 months of age (P1). Eight children were lost to follow-up.

Independent of maternal status and delivery type, confirmed vertical transmission of HIV-1-infected women who received ZDV is 4.25 per cent. Prenatal care with a multidisciplinary team is necessary for good obstetric and newborn outcomes.