Therapeutic and other interventions to reduce the risk of mother-to-child transmission of HIV-1 in Europe. The European Collaborative Study.

OBJECTIVES

To document policies regarding the use of interventions to reduce risk of vertical transmission of human immunodeficiency virus (HIV) and assess the extent of changes since 1994.

DESIGN

A postal questionnaire survey and data from the European Collaborative Study (ECS), a prospective multi-centre cohort study.

SETTING

Fifty-four obstetric centres in 16 European countries.

SAMPLE

A questionnaire response from 54 obstetricians; 669 deliveries to HIV-infected women enrolled in the ECS from 1994 to 1997.

MAIN OUTCOME MEASURES

Use of zidovudine during pregnancy, at delivery and to the neonate; caesarean section delivery rates; vaginal lavage; avoidance of breastfeeding; vertical transmission rate.

RESULTS

Zidovudine therapy to reduce vertical transmission is now widespread in Europe and routine in all but one centre surveyed, although regimens vary. In 11 (26%) centres elective caesarean section is offered to all HIV-infected women and a further nine (21%) have a policy of routine vaginal lavage. In all centres HIV-infected women are advised to avoid breastfeeding. In the ECS there has been a significant temporal decline in the vertical transmission rate with an increase in zidovudine use. More than 90% of women in the ECS who were delivered in 1997 received one or more components of zidovudine therapy; the rate of vertical transmission is 9% where zidovudine has been used, compared with 15% without use of zidovudine.

CONCLUSIONS

Although the use of zidovudine to reduce vertical transmission is increasing in Europe and, with the avoidance of breastfeeding, is associated with a decline in vertical transmission, the success of these interventions will be limited by the uptake of antenatal screening.