Prevention of Mother to Child Transmission of HIV Use of antiretroviral therapy after first trimester (3 months) of pregnancy has shown to reduce the rate of maternal transmission of HIV to newborn. Antiretroviral therapy is not recommended in the first three months of pregnancy as it may have teratogenic effects on the infant, which may lead to abnormal formation of vital organs.
Protocol 076 regimen The Protocol 076 regimen, initiated after the first trimester, should be recommended for all pregnant women with HIV infection.
Oral administration of 100 mg Zidovudine (ZDV) 5 times daily, initiated at 14-34 weeks gestation and continued throughout the pregnancy.
Single 200 mg oral dose at onset of labourInfant postpartum dose
Single 2 mg/kg oral dose at age 48-72 hours*
*If the mother received Nevirapine less than one hour prior to delivery, the infant should be given 2 mg/kg oral Nevirapine as soon as possible after birth and again at 48-72 hours.
ZDV 600 mg orally at onset of labour, followed by 300 mg orally every 3 hours until delivery and 3TC 150 mg orally at onset of labour, followed by 150 mg orally every 12 hours until delivery.Infant postpartum dose
ZDV 4 mg/kg orally every 12 hours and 3TC 2 mg/kg orally every 12 hours for seven days.
|Combined use of C-section and ZDV||0% (0 out of 31)|
|Elective C-section without ZDV||8% (7 out of 86)|
|ZDV alone||17% (4 out of 24)|
|No intervention||20% (55 out of 271)|
HIV transmission rates were as follows:
|At birth||8.1 %||10.3 %|
|At 6-8 weeks||11.8 %||20 %|
|At 14-16 weeks||13.6 %||22.1 %|
This study concluded that Nevirapine lowered the risk of HIV-1 transmission by almost 50% in a breast-feeding population. This simple and relatively inexpensive regimen could decrease maternal transmission in developing countries.
Choice of regimen for prevention of MTCT
The choice of regimen for a particular patient is decided after taking into factors such as: