Preventing Mother-to-Child Transmission of HIV with Zidovudine

Introduction to Zidovudine Prophylaxis

The Centers for Disease Control and Prevention recommends that zidovudine should be administered to all infants born to HIV-positive mothers, starting within 6-12 hours of birth and continuing for 6 weeks, with the specific regimen determined by the mother's antiretroviral therapy status and viral load during pregnancy 1, 2, 3

For infants whose mothers received adequate antiretroviral therapy during pregnancy with viral suppression, the American Academy of Pediatrics recommends administering zidovudine 4 mg/kg orally twice daily for 6 weeks 4, 5
The World Health Organization suggests beginning treatment within 6-12 hours of birth for maximum effectiveness 4

For infants whose mothers received no antiretroviral therapy before or during labor, the Centers for Disease Control and Prevention recommends administering single-dose nevirapine 2 mg/kg oral suspension immediately after birth or within 72 hours, plus zidovudine 4 mg/kg orally twice daily for 6 weeks 2, 3, 4, 6
This combination regimen reduces transmission by approximately two-thirds compared to no treatment, according to the National Institutes of Health 1

The American College of Obstetricians and Gynecologists states that zidovudine must be initiated within 6-12 hours of birth for optimal effectiveness, as transmission rates increase to 18% when delayed beyond 48 hours 4
The World Health Organization notes that transmission rates reach 27% with no prophylaxis 4

The National Institutes of Health recommends the landmark ACTG 076 regimen, which includes three components: antepartum, intrapartum, and neonatal zidovudine, and reduces perinatal HIV transmission from 25.5% to 8.3% 1

The Centers for Disease Control and Prevention suggests that for infants ≥4 weeks to 2 years old when zidovudine cannot be given, dolutegravir plus two NRTIs is the preferred alternative 4
The World Health Organization recommends raltegravir plus two NRTIs as a secondary alternative for infants ≥2 kg, and lopinavir/ritonavir plus two NRTIs as another secondary alternative 4