3rd Conference on Retroviruses and Opportunistic Infections Washington, DC - January 28-February 1, 1996

Conf Retroviruses Opportunistic Infect 1996 Jan 28-Feb 1; 3rd:57 (abstract no. 26)

Cooper E, Diaz C, Pitt J, Hanson C, Hershow R, Kalish L, Mendez H, Zorilla C, Moye J, Smeriglio V, Fowler MG
The Women and InfantsTransmission Study (WITS) Group, NIH, Bethesda, MD.

PURPOSE: To determine the impact of the 2/94 release of ACTG 076 results on vertical transmission rate (TR) in a cohort of mother-infant pairs enrolled since 1989, and followed in New York, Chicago, Houston, Boston, and Puerto Rico (WITS).

METHODS: TR were calculated for 453 infants born on or before, and 103 infants born after, 3/1/94. Infection was established by 2 positive HIV cultures. TR were estimated by the Kaplan-Meier method and, among infants greater than 6 months of age, by simple proportion.

RESULTS: Pre- and post-3/l/94 TR fell from 19% to 8% (X² 7.52; p 0.006). Kaplan-Meier analysis revealed similar results (18% vs. 7%; log-rank p= 0.007). ZDV use in pregnancy and in newborns rose dramatically (22% vs. 89% and 1% vs. 79%). Both cohorts were similar with respect to maternal % CD4, gestational age, mode of delivery, trimester of enrollment, and demographics (race, age, ethnicity). Duration of membrane rupture greater than 4 hrs and maternal illicit drug use decreased after 3/1/94 (44% vs. 27% and 47% vs. 27%), but there was a reduction in TR with and without these risk factors after 3/1/94. TR was calculated separately for the 96 ZDV users before 3/l/94 and compared to that for the 91 after 3/1/94 (15.6% vs. 7.7%). ZDV users pre- vs. post-3/l/94 were more immunocompromised, with % CD4 less than 14 (21% vs. 12%), and did not receive the intrapartum or infant components of the ACTG 076 regimen. Hematologic toxicity was similar in infants exposed vs. unexposed to ZDV; maternal ZDV use did not delay diagnosis of infant infection.

CONCLUSIONS: In a large perinatal HIV observational study (WITS), release of ACTG 076 results was temporally associated with a dramatic increase in ZDV use in pregnancy, and significant decrease in maternal-infant HIV transmission.

960128
26

Copyright © 1996 - Foundation for Retrovirology and Human Health . Reproduction of this abstract (other than one copy for personal reference) must be cleared through the Foundation for Retrovirology and Human Health.