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

MMWR

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BOX 3. Summary: Clinical situations and recommendations for use of zidovudine*
to reduce perinatal HIV transmission
I. Pregnant HIV-infected women with CD4+ T-lymphocyte counts 200/gL
who are at 14-34 weeks of gestation and who have no clinical indications
for ZDV and no history of extensive (>6 months) prior antiretroviral therapy.
Recommendation:
The health-care provider should recommend the full ACTG Protocol 076
regimen to all HIV-infected pregnant women in this category. This recommendation should be presented to the pregnant woman in the context of a
risk-benefit discussion: a reduced risk of transmission can be expected, but
the long-term adverse consequences of the regimen are not known. The decision about this regimen should be made by the woman after discussion
with her health-care provider.
II. Pregnant HIV-infected women who are at >34 weeks of gestation, who
have no history of extensive (>6 months) prior antiretroviral therapy, and
who do not require ZDV for their own health.
Recommendation:
The health-care provider should recommend the full ACTG Protocol 076
regimen in the context of a risk-benefit discussion with the pregnant
woman. The woman should be informed that ZDV therapy may be less effective than that observed in ACTG Protocol 076, because the regimen is
being initiated late in the third trimester.
Ill. Pregnant HIV-infected women with CD4+ T-lymphocyte counts <200/pL
who are at 14-34 weeks of gestation, who have no other clinical indications
for ZDV, and who have no history of extensive (>6 months) prior antiretroviral therapy.
Recommendation:
The health-care provider should recommend initiation of antenatal ZDV
therapy to the woman for her own health benefit. The intrapartum and neonatal components of the ACTG Protocol 076 regimen should be
recommended until further information becomes available. This recommendation should be presented in the context of a risk-benefit discussion
with the pregnant woman.
IV. Pregnant HIV-infected women who have a history of extensive (>6 months)
ZDV therapy and/or other antiretroviral therapy before pregnancy.
Recommendation:
Because data are insufficient to extrapolate the potential efficacy of the
ACTG Protocol 076 regimen for this population of women, the health-care
provider should consider recommending the ACTG Protocol 076 regimen
*These recommendations do not represent approval by the Food and Drug Administration
(FDA) or approved labeling for the particular product or indications in question.