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

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MMWR

August 5, 1994

BOX 3. Summary: Clinical situations and recommendations for use of zidovudine
to reduce perinatal HIV transmission (Continued)
on a case-by-case basis after a discussion of the risks and benefits with the
pregnant woman. Issues to be discussed include her clinical and immunologic stability on ZDV therapy, the likelihood she is infected with a
ZDV-resistant HIV strain, and, if relevant, the reasons for her current use of
an alternative antiretroviral agent (e.g., lack of response to or intolerance of
ZDV therapy). Consultation with experts in HIV infection may be warranted.
The health-care provider should make the ACTG Protocol 076 regimen available to the woman, although its effectiveness may vary depending on her
clinical status.
V. Pregnant HIV-infected women who have not received antepartum antiretroviral therapy and who are in labor.
Recommendation:
For women with HIV infection who are in labor and who have not received
the antepartum component of the ACTG Protocol 076 regimen (either because of lack of prenatal care or because they did not wish to receive
antepartum therapy), the health-care provider should discuss the benefits
and potential risks of the intrapartum and neonatal components of the
ACTG Protocol 076 regimen and offer ZDV therapy when the clinical situation permits.
VI. Infants who are born to HIV-infected women who have received no intrapartum ZDV therapy.
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.