Prescrire Int. 2000 Jun;9(47):92-5.
(1) Since 1994, zidovudine administration to pregnant women and their newborns has been the reference prophylaxis for mother-child HIV transmission. (2) Three trials done in Thailand and Africa show that zidovudine therapy during the last few weeks of pregnancy reduces the risk of transmission, especially when breast-feeding is avoided. (3) A retrospective study done in the United States suggests that even very late zidovudine administration may benefit the mother and/or her child. (4) A trial done in Uganda suggests that a single dose of nevirapine has better preventive activity than a very short course of zidovudine in women who breastfeed. (5) There are very few data on the risk-benefit ratio of multidrug antiretroviral regimens in pregnant women. (6) Eight cases of mitochondrial involvement have been diagnosed in France in children exposed to zidovudine or to the zidovudine + lamivudine combination. These cases call for long-term close monitoring of children exposed to antiretroviral drugs in utero. To limit the duration of fetal exposure, the third trimester of pregnancy is now recommended as the safest time to start antiretroviral prophylaxis. (7) Despite a randomised trial and a meta-analysis suggesting that elective caesarean section prevents mother-child HIV transmission, the value of such surgery remains controversial.
(1) 自1994年以来，对孕妇及其新生儿使用齐多夫定一直是预防母婴传播艾滋病毒的标准方法。(2) 在泰国和非洲进行的三项试验表明，在怀孕最后几周进行齐多夫定治疗可降低传播风险，尤其是在避免母乳喂养的情况下。(3) 美国进行的一项回顾性研究表明，即使很晚才使用齐多夫定也可能对母亲和/或其孩子有益。(4) 在乌干达进行的一项试验表明，对于进行母乳喂养的女性，单剂量奈韦拉平的预防效果优于短疗程的齐多夫定。(5) 关于孕妇使用多种抗逆转录病毒药物治疗方案的风险效益比的数据非常少。(6) 在法国，已有8例暴露于齐多夫定或齐多夫定+拉米夫定联合用药的儿童被诊断出线粒体受累。这些病例需要对子宫内暴露于抗逆转录病毒药物的儿童进行长期密切监测。为了限制胎儿暴露的时间，现在建议将妊娠晚期作为开始抗逆转录病毒预防的最安全时间。(7) 尽管一项随机试验和一项荟萃分析表明选择性剖宫产可预防母婴传播艾滋病毒，但这种手术的价值仍存在争议。
