Table 1.

US Public Health Service Recommendations for Use of Zidovudine to Reduce Perinatal HIV Transmission

Clinical ScenarioRecommendations
CD4+≥200/mm3Risk vs benefit discussion
 14–34 weeks of gestationRecommend full ACTG-076 zidovudine regimen
 No maternal clinical indication for zidovudine
CD4+≥200/mm3Risk vs benefit discussion
 >34 weeks of gestationRecommend full ACTG-076 zidovudine regimen
 No maternal clinical indication for zidovudine
 No extensive history (>6 mo) of prior zidovudineMay be less effective because therapy is initiated late
CD4+<200/mm3Risk vs benefit discussion
 14–34 weeks of gestationRecommend antenatal zidovudine therapy for woman's health
 No extensive history (>6 mo) of prior zidovudineRecommend intrapartum and neonatal components of ACTG-076 zidovudine regimen
Significant prior administration of zidovudine or other Risk vs benefit discussion
 antiretroviral therapy (>6 mo)Recommend zidovudine therapy on a case-by-case basis
Issues to consider
  Likelihood of resistance to therapy
  Duration of prior zidovudine therapy
  Reason alternative therapy was given, if received (intolerance   vs progression of disease despite therapy)
Woman is in labor and has not had antepartum Risk vs benefit discussion
 zidovudine therapyDiscuss and offer intrapartum and neonatal ZDV if clinical situation permits
Infant is born to a woman who has not received Risk vs benefit discussion
 intrapartum zidovudineIf ≤24 h old and clinical situation permits:
  Discuss and offer neonatal zidovudine
  Start zidovudine as soon as possible after birth
If >24 h old: no data support offering zidovudine therapy