Los Angeles Times - Tuesday, April 24, 2001

Use of zidovudine -AZT -alone is generally recommended for HIV-infected pregnant women and their newborns. It has been shown to sharply reduce the chances of a mother transmitting the virus to her baby during childbirth or shortly thereafter.

In the study published Wednesday in the Journal of the American Medical Association, researchers found that combining AZT with lamivudine, or 3TC, resulted in a transmission rate that was five times lower than the rate found in a group that received just AZT.

Blood abnormalities were found in newborns in both groups, but they were more severe in the combined drug group and two infants died. The virus also showed signs of growing resistant to 3TC in about 40 percent of women tested.

Given the mixed results, the authors said more data is needed to determine whether the benefits of combined drug treatment in pregnancy outweigh the risks.

Both AZT and 3TC are older AIDS drugs known as nucleoside analogs. The authors did not examine the newer protease inhibitors, which have made AIDS a more manageable disease but have been less studied in pregnant women.

In the study, 445 HIV-infected pregnant women were given the combined drugs and 899 received AZT alone. The drugs were given to the women during pregnancy and to their newborns for six weeks after birth.

The rate of mother-child transmission was 6.8 percent in the AZT group. It was only 1.6 percent in the combined-drug group, "which, to our knowledge, is the lowest rate reported to date in a large, prospective study," said the authors, led by Dr. Laurent Mandelbrot of the Hospital Cochin in Paris.

The authors took into account rates in both groups for Caesarean deliveries, which can dramatically reduce mother-child transmission rates.

Frequency of newborn blood abnormalities such as anemia and low white-cell counts was about equal in both groups but more severe in the combined drug group. Nine of those children required blood transfusions and treatment was discontinued in 19 others.

Two infants in the ATC-3TC group who had cell damage linked to nucleoside analog drugs died at age 1.

Dr. Nathan Shaffer, an AIDS researcher at the federal Centers for Disease Control and Prevention, said the combined drugs' success at preventing mother-child transmission was impressive.

In a JAMA editorial, Shaffer said giving 3TC to pregnant mothers and not their infants might help reduce side effects. He suggested that fine-tuning the use of combined treatment in pregnancy along with Caesarean delivery has the potential of virtually eliminating mother-child AIDS transmission in developed countries.

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