| Pregnancy, Pediatrics
and HIV Infection: Guidelines for Your Practice Page 6 |
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| Result of Efforts in
New Jersey to Reduce Perinatal HIV Transmission
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| Between 1993 and 1999, there has been a marked increase in the use of AZT in New Jersey to reduce the risk of perinatal HIV transmission. | ||||||||||||||||||||||||||||||||||
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| In 1993, only 72% of women knew their HIV status before giving birth. In 1999, 95% of women knew. Surveillance data indicate that compliance with AZT during the prenatal, intrapartum, and neonatal period is approximately 68%. A 1997-1999 survey conducted by the New Jersey Department of Health and Senior Services was directed toward childbearing women to evaluate implementation of Public Health Services recommendations on the use of AZT to prevent perinatal HIV transmission. The survey revealed that 60% to 70% of HIV-infected pregnant women in New Jersey had evidence of AZT. | ||||||||||||||||||||||||||||||||||
| Efforts to ensure that women seek prenatal care, undergo counseling and testing, and use AZT as part of the antiretroviral regimen have markedly decreased perinatal transmission in New Jersey. In 1993, 21.1% of perinatally exposed children became infected with HIV. Preliminary data through September 30, 2000 indicate that in 1999 only 3.8% perinatally exposed children became infected with HIV-a decline of infections by 80%. Continued improvement will require doubling efforts to offer testing, provide antiretroviral agents, and counsel women about Cesarean sections for those who are medically eligible for them. | ||||||||||||||||||||||||||||||||||
| Short- and Long-Term Effects of AZT | ||||||||||||||||||||||||||||||||||
| In 1998, Lorenzi et al reported a possible association between combination antiretroviral therapy and a higher risk of preterm labor.5 Review of the US cohort by the CDC Public Health Service Task Force did not support this association; however, pregnant women who are on combination antiretroviral therapy should be informed about the signs of preterm labor and instructed on a course of action.6 | ||||||||||||||||||||||||||||||||||
| Women and children who participated in PACTG 076 have been followed to determine the short- and long-term effects of AZT. There was no difference in clinical disease progression, AIDS cases, deaths, or CD4 after a four-year follow-up among randomized women11 to the AZT or placebo arm of the PACTG 076 study. | ||||||||||||||||||||||||||||||||||
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