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ART & PREGNANCY

last updated: January 24, 2001

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TABLE 4. Comparison of Intrapartum/Postpartum Regimens for HIV-Infected Women in Labor Who Have Had No Prior Antiretroviral Therapy (Scenario 3)
Drug Regimen	Source of Evidence	Maternal Intrapartum	Infant Postpartum	Data on Transmission	Advantages	Disadvantages
Nevirapine	Clinical trial, Africa; compared to oral ZDV given intrapartum and for 1 week to the infant	Single 200 mg oral dose at onset of labor	Single 2 mg/kg oral dose at age 48-72 hours* *If the mother received nevirapine less than 1 hour prior to delivery, the infant was given 2 mg/kg oral nevirapine as soon as possible after birth and again at 48-72 hours.	Transmission at 6 weeks 12% with nevirapine compared to 21% with ZDV, a 47% (95% CI, 20-64%) reduction	Inexpensive Oral regimen Simple, easy to administer Can give directly observed treatment	Unknown efficacy if mother has nevirapine-resistant virus
ZDV/3TC	Clinical trial, Africa; compared to placebo	ZDV 600 mg orally at onset of labor, followed by 300 mg orally every 3 hours until delivery AND 3TC150 mg orally at onset of labor, followed by 150 mg orally every 12 hours until delivery	ZDV 4 mg/kg orally every 12 hours AND 3TC 2 mg/kg orally every 12 hours for 7 days	Transmission at 6 weeks 10% with ZDV/3TC compared to 17% with placebo, a 38% reduction	Oral regimen Compliance easier than 6 weeks of ZDV alone as infant regimen is only 1 week	Potential toxicity of multiple drug exposure
ZDV	Epidemiologic data, U.S.; compared to no ZDV treatment	2 mg/kg intravenous bolus, followed by continuous infusion of 1 mg/kg/hr until delivery	2 mg/kg orally every 6 hours for 6 weeks	Transmission 10% with ZDV compared to 27% with no ZDV treatment, a 62% (95% CI, 19-82%) reduction	Has been standard recommendation before clinical trial results	Requires intravenous administration and availability of ZDV intravenous formulation Compliance with 6 week infant regimen
ZDV and Nevirapine	Theoretical	ZDV 2 mg/kg intravenous bolus, followed by continuous infusion of 1 mg/kg/hr until delivery AND Nevirapine single 200 mg oral dose at onset of labor	ZDV 2 mg/kg orally every 6 hours for 6 weeks AND Nevirapine single 2 mg/kg oral dose at age 48-72 hours	No data	Potential benefit if maternal virus is resistant to either nevirapine or ZDV Synergistic inhibition of HIV replication with combination in vitro	Requires intravenous administration and availability of ZDV intravenous formulation Compliance with 6 week infant ZDV regimen Unknown efficacy and limited toxicity data

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