Abstract
New Pediatric AIDS Clinical Trials Group (PACTG) protocol 076 data provided by Shapiro et al. highlight several important questions. The short-course Bangkok regimen mainly prevents intrapartum transmission which accounts for about 75% of vertical HIV transmission in the absence of breast-feeding. The PACTG 076 data suggest that longer antenatal treatment also reduces in-utero transmission and that infant treatment also helps to reduce in-utero and intrapartum transmission. It is unclear why the reduction in viral load was so low in the PACTG 076 trial but the nature of specimen processing assay methods adherence or viral subtypes may be factors. Shapiro et al.s suggestion that a meta-analysis of the Bangkok PACTG 076 and other trials could shed light upon how and when zidovudine protects against perinatal HIV transmission is valid. In response to Wilsons critique the authors study was designed to assess antenatal zidovudine for reducing perinatal HIV-1 transmission. Providing medical care for study subjects was the responsibility of coinvestigator obstetricians and pediatricians. The constraints faced by Thailands health care system in providing effective and comprehensive care for people with AIDS are described. Advocacy groups should help patients obtain the best care and social support they can.
Published Version
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