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April 25, 2001

Combination Prophylaxis for Prevention of Maternal-Infant HIV TransmissionBeyond 076

Author Affiliations

Author Affiliations: MTCT Unit, Global AIDS Program, Centers for Disease Control and Prevention, Atlanta, Ga.

JAMA. 2001;285(16):2129-2131. doi:10.1001/jama.285.16.2129

Since 1994, rapid implementation of the landmark ACTG 076 study regimen has led to a dramatic reduction in perinatal HIV (human immunodeficiency virus) transmission in the United States and other developed countries.1 Cohort studies, registries, and surveillance data have all confirmed the effectiveness of the 3-part zidovudine monotherapy regimen, administered orally to the pregnant woman beginning at 14 to 34 weeks' gestation, intravenously during labor, and orally to the newborn for 6 weeks. In the absence of breastfeeding, use of this regimen has resulted in perinatal transmission rates of 4% to 10% in the United States and Europe.2 In conjunction with the 076 regimen, elective caesarean delivery or combination antiretroviral therapy has resulted in transmission rates of less than 2%.24 Although the data on combination therapy have been quite limited, there is a growing conviction that perinatal HIV transmission can be reduced to near zero with early identification of the HIV-infected pregnant woman and aggressive clinical management.5

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