Recommendations of the U.S. Public Health Service Task Force on the Use of Zidovudine to Reduce Perinatal Transmission of Human Immuno deficiency Virus

Vol. 43 / No. RR-11

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At least 13 reports have described the failure of prophylactic ZDV to prevent
HIV infection in humans following exposure to HIV-infected blood, even though
the drug was administered promptly after exposure (52). Although these anecdotal reports do not establish that ZDV therapy is ineffective as postexposure
prophylaxis, its efficacy can be expected to be lower in this situation than with
the full regimen. Further studies are needed to evaluate whether a therapy administered only during the neonatal period can effectively prevent perinatal
transmission.
Recommendation:
If the clinical situation permits and if ZDV therapy can be initiated within 24
hours of birth, the health-care provider should offer the ACTG Protocol 076 postpartum component of 6 weeks of neonatal ZDV therapy for the infant in the
context of a risk-benefit discussion with the mother. Data from animal prophylaxis studies indicate that, if ZDV is administered, therapy should be initiated as
soon as possible (within hours) after delivery. If therapy cannot begin until the
infant is >24 hours of age and the mother did not receive therapy during labor,
no data support offering therapy to the infant.
RECOMMENDATIONS FOR MONITORING THE ZDV REGIMEN
FOR MOTHERS AND INFANTS
Women and their children should receive care together in a family-centered setting.
Care should be coordinated between gynecologic, pediatric, internal medicine, infectious disease, and other health-care specialists to ensure that both mother and child
receive appropriate medical follow-up. A comprehensive program of support services
is necessary to ensure that both mother and child continue to receive health care.
Maternal Monitoring
HIV-infected pregnant women should be monitored in accordance with previously
published guidelines (31,53). Monitoring during pregnancy should include monthly
assessment for ZDV-associated hematologic and liver chemistry abnormalities. Indications of toxicity that might require interrupting or stopping the dose of ZDV include
a) hemoglobin <8 gm/dL, b) absolute neutrophil count <750 cells/pL, or c) AST (SGOT)
or ALT (SGPT) greater than five times the upper limit of normal.
CD4+ T-lymphocyte counts should be monitored to determine if prophylaxis for
opportunistic infections, such as Pneumocystis carinii pneumonia (PCP), should be
initiated. Pregnant HIV-infected women with CD4+ T-lymphocyte counts <200 cells/pL
should receive appropriate PCP prophylaxis. If the CD4+ T-lymphocyte count is <600
cells/pL, the evaluation should be repeated each trimester. CD4+ T-lymphocyte counts
should be measured at 6 weeks and 6 months postpartum to evaluate if antiretroviral
therapy is indicated.
Fetal Monitoring
Antepartum testing, including sonographic and nonstress testing and intrapartum
fetal monitoring, should be performed only as clinically indicated, not specifically
because the patient is being treated with ZDV during pregnancy.