Management of HIV infection during pregnancy: new options, new questions

ACTG 076 demonstrated that the frequency of perinatal HIV transmission can be reduced by administering AZT to HIV-infected pregnant women and their newborns. The rate of vertical transmission in ACTG 076 was approximately eight percent, or one-third of the rate among infants of untreated mothers. This information has affected the clinical management of HIV-infected pregnant women. Commonly raised questions address the validity of HIV testing and counseling for all pregnant women; the effects of pregnancy on HIV disease progression; the times in pregnancy when AZT treatment is appropriate; the relation of CD4 counts to AZT administration; the administration of other antiviral medications to women who have developed resistance to AZT; the recommended prophylactic therapy for opportunistic infections; the prevention of primary toxoplasma and CMV infection; the management of labor; and the benefits of AZT. These questions are answered in the context of clinical, ethical, and cost-benefit issues as they relate to pregnant women and their infants.