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C-Section and HIV Transmission with Zidovudine

It is not clear what role the mode of delivery plays in perinatal HIV transmission. Since the widespread adoption of zidovudine prophylaxis in pregnant women in 1994, perinatal transmission has decreased by about two thirds, to about 6%. This study from the French Perinatal Cohort examined the effect of cesarean section and zidovudine use on transmission in 2,819 HIV-infected mothers and their children.

In 1,877 mothers not using zidovudine, the rate of transmission was 17.6%. Risk factors for transmission were p24 anteginemia (odds ratio, 2.8), bloody amniotic fluid (OR, 5.1), and cervicovaginal infection (OR, 1.6). Delivery mode had no impact on transmission in these mothers. In 902 mothers who were using zidovudine, over-all transmission to infants was 6.4%. Delivery method significantly affected transmission; transmission rates were 0.8%, 6.6%, and 11.4% with elective cesarean section, vaginal delivery, and emergent cesarean, respectively. In a multivariate analysis, meconium-stained amniotic fluid (OR, 2.4) and p24 antiginemia (OR, 3.3) were also significant risk factors among zidovudine-treated women.

Comment: Since cesarean section is associated with higher mortality rates, postpartum complications, and expense, it is premature at this point to recommend elective C-section for all HIV-infected pregnant women taking zidovudine prophylaxis. Studies are under way to determine whether the addition of another antiretroviral can further reduce perinatal HIV transmission.

— SD Gharib

Published in Journal Watch Women's Health August 1, 1998

Citation(s):

Mandelbrot L et al. Perinatal HIV-1 transmission: Interaction between zidovudine prophylaxis and mode of delivery in the French Perinatal Cohort. JAMA 1998 Jul 1 280 55-60.

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