Highly Active Antiretroviral Therapy in Neonates and Young Infants

SINCE THE U.S. PUBLIC HEALTH Service published its guidelines for the reduction of vertical transmission of human immunodeficiency virus (HIV) in 1994, Pediatric AIDS Clinical Trials Group (PACTG) 076 zidovudine (ZDV) regimen (Table 1) has been the standard of care in developed countries.¹ The initial study of ZVD administration in mother-infant pairs demonstrated a significant reduction in vertical transmission of HIV-1: 7.6 percent in the treatment group versus 22.6 percent in the placebo group.² Clearly, early and adequate prenatal care for the management of the HIVinfected pregnant woman is the key to providing the best possible outcome for the mother and her infant. However, women seek prenatal care at various stages of their pregnancies, and some present to labor and delivery suites having had no prenatal care. Thus, the Perinatal HIV Guidelines Working Group developed recommendations for prophylaxis against mother-to-child transmission of HIV that cover a variety of clinical scenarios.³ Discussion of these recommendations is beyond the scope of this article, but readers can find the recommendations at http://AIDSinfo.nih.gov.