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Therapeutic and other interventions to reduce the risk of mother‐to‐child transmission of HIV‐1 in Europe
Publication year - 1998
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.1998.tb10199.x
Subject(s) - zidovudine , breastfeeding , medicine , transmission (telecommunications) , psychological intervention , caesarean section , pregnancy , vaginal delivery , obstetrics , pediatrics , prospective cohort study , human immunodeficiency virus (hiv) , family medicine , surgery , psychiatry , viral disease , biology , electrical engineering , genetics , engineering
Objectives To document policies regarding the use of interventions to reduce risk of vertical transmission of human immunodeficiency virus (HIV) and assess the extent of changes since 1994. Design A postal questionnaire survey and data from the European Collaborative Study (ECS), a prospective multi‐centre cohort study. Setting Fifty‐four obstetric centres in 16 European countries. Sample A questionnaire response from 54 obstetricians; 669 deliveries to HIV‐infected women enrolled in the ECS from 1994 to 1997. Main outcome measures Use of zidovudine during pregnancy, at delivery and to the neonate; caesarean section delivery rates; vaginal lavage; avoidance of breastfeeding; vertical transmission rate. Results Zidovudine therapy to reduce vertical transmission is now widespread in Europe and routine in all but one centre surveyed, although regimens vary. In 11 (26%) centres elective caesarean section is offered to all HIV‐infected women and a further nine (21%) have a policy of routine vaginal lavage. In all centres HIV‐infected women are advised to avoid breastfeeding. In the ECS there has been a significant temporal decline in the vertical transmission rate with an increase in zidovudine use. More than 90% of women in the ECS who were delivered in 1997 received one or more components of zidovudine therapy; the rate of vertical transmission is 9% where zidovudine has been used, compared with 15% without use of zidovudine. Conclusions Although the use of zidovudine to reduce vertical transmission is increasing in Europe and, with the avoidance of breastfeeding, is associated with a decline in vertical transmission, the success of these interventions will be limited by the uptake of antenatal screening.