Effect of perinatal short-course zidovudine on the clinical and virological manifestations of HIV-1 subtype E infection in infants.

BACKGROUND

The perinatal short-course zidovudine (ZDV) chemoprophylaxis that can reduce HIV-1 vertical transmission by 51% has been widely practiced in developing countries such as Thailand because of its simpler and less cost.

OBJECTIVES

To investigate the effects of short-course regimen of oral ZDV for prophylaxis of HIV-1 subtype E vertical transmission among 'break-through' HIV-1 infected infants.

STUDY DESIGN

The study analyzed clinical and virological outcomes of 80 infants, whose mothers received ZDV prophylaxis starting at 36 weeks gestation (group Z) and 37 infants whose mothers never received anti-retroviral drugs (group C), at the ages of 1-2, 4-6, and 12 months.

RESULTS

Of the 12 HIV-1 infected infants, 5/7 (71.4%) from group Z and 1/5 (20%) from group C progressed to a symptomatic clinical stage by the age 4-6 months. The intersample nucleotide distance of HIV-1 pol reverse transcriptase (RT) sequences of isolates collected at age of 1-2 months from group Z was significantly higher than that from group C (3.34 and 2.92%, P=0.02). All twelve virus isolates from infected infants were non syncytium inducing (NSI) and macrophage tropic strains; and 5/6 (83.3%) viruses from symptomatic infants were also T-tropic viruses. The symptomatic infants also had significantly higher HIV-1 nucleic acid quantitation than asymptomatic infants.

CONCLUSION

Our results preliminary suggested that infected infants who were perinatally exposed to ZDV may have a more rapid early disease progression with unfavorable viral manifestations than those without exposure to antiretroviral drug.