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Acute decrease in HIV-1 viral load after initiation of zidovudine therapy: implications for interrupting vertical
1Institute of Pathology and Department of Geographic Medicine, Case Western Reserve University, University Hospitals of Cleveland, OH, USA.
Use of zidovudine (AZT) in pregnant women has recently been reported to reduce the rate of vertical transmission of human immunodeficiency virus type 1 (HIV-1) possibly through a reduction in maternal viral load. To determine how quickly AZT is able to reduce viral load, infectious virus and plasma HIV-1 RNA were sequentially measured in an HIV-1-infected patient at short intervals (hours) after initiation of oral AZT. Peripheral blood samples were collected at baseline, 1, 2, 4, 8, 12, 24, 48 hours, and 1 week after initiation of AZT therapy (500 mg/day) for quantitative plasma HIV-1 RNA levels, p24 antigen levels, and AZT levels. Quantitative HIV-1 peripheral blood mononuclear cell and plasma cultures, CD4 cell counts, and MT-2 cell assays for syncytium-inducing phenotype were performed at baseline, 1, 2 days, and 1 week after initiation of AZT therapy. A significant drop in viral load did not occur until after 24-48 hours. AZT should probably be administered at least 2 days prior to anticipated delivery, if a reduced maternal viral load is responsible for AZT's efficacy in preventing vertical transmission.
Use of zidovudine (AZT) in pregnant women has recently been reported to reduce the rate of vertical transmission of human immunodeficiency virus type 1 (HIV-1) possibly through a reduction in maternal viral load. To determine how quickly AZT is able to reduce viral load, infectious virus and plasma HIV-1 RNA were sequentially measured in an HIV-1-infected patient at short intervals (hours) after initiation of oral AZT. Peripheral blood samples were collected at baseline, 1, 2, 4, 8, 12, 24, 48 hours, and 1 week after initiation of AZT therapy (500 mg/day) for quantitative plasma HIV-1 RNA levels, p24 antigen levels, and AZT levels. Quantitative HIV-1 peripheral blood mononuclear cell and plasma cultures, CD4 cell counts, and MT-2 cell assays for syncytium-inducing phenotype were performed at baseline, 1, 2 days, and 1 week after initiation of AZT therapy. A significant drop in viral load did not occur until after 24-48 hours. AZT should probably be administered at least 2 days prior to anticipated delivery, if a reduced maternal viral load is responsible for AZT's efficacy in preventing vertical transmission.