FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Volume 335:1621-1629 November 28, 1996 Number 22 Next

	Full Text PDF Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background and Methods A placebo-controlled trial has shown that treatment with zidovudine reduces the rate at which human immunodeficiency virus type 1 (HIV-1) is transmitted from mother to infant. We present data from that trial showing the number of infected infants at 18 months of age and the relation between the maternal viral load, the risk of HIV-1 transmission, and the efficacy of zidovudine treatment. Viral cultures were obtained, and HIV-1 RNA was measured by two assays in samples of maternal blood obtained at study entry and at delivery.

Results In 402 mother–infant pairs, the rate of transmission of HIV-1 was 7.6 percent (95 percent confidence interval, 4.3 to 12.3 percent) with zidovudine treatment and 22.6 percent (95 percent confidence interval, 17.0 to 29.0 percent) with placebo (P<0.001). In the placebo group, a large viral burden at entry or delivery or a positive culture was associated with an increased risk of transmission (the transmission rate was greater than 40 percent in the highest quartile of the RNA level). In both groups, transmission occurred at a wide range of maternal plasma HIV-1 RNA levels. Zidovudine reduced plasma RNA levels somewhat (median reduction, 0.24 log). Zidovudine was effective regardless of the HIV-1 RNA level or the CD4+ count at entry. In the zidovudine group, however, after we adjusted for the base-line HIV-1 RNA level and CD4+ count, the reduction in viral RNA from base line to delivery was not significantly associated with the risk of transmission of HIV-1.

Conclusions A high maternal plasma concentration of virus is a risk factor for the transmission of HIV-1 from an untreated mother to her infant. The reduction in such transmission after zidovudine treatment is only partly explained by the reduction in plasma levels of viral RNA. To prevent HIV-1 transmission, initiating maternal treatment with zidovudine is recommended regardless of the plasma level of HIV-1 RNA or the CD4+ count.

Source Information

From the Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, New York (R.S.S.); the Statistical and Data Analysis Center, Pediatric AIDS Clinical Trials Group, Harvard School of Public Health, Boston (D.E.S.); University of Washington School of Medicine, Seattle (R.W.C.); Chiron Corporation, Emeryville, Calif. (J.A.T.); Roche Molecular Systems, Branchburg, N.J. (S.A.H.); Department of Pediatrics, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark (G.D.M.); University of Miami School of Medicine, Miami (M.J.O.); Tulane University School of Medicine, New Orleans (R.B.V.); San Juan City Hospital, San Juan, P.R. (E.J.); Agence Nationale de Recherche sur le SIDA–Hôpital Necker, Paris (C.R.); St. Jude Children's Research Hospital, Memphis, Tenn. (P.M.F.); and the University of Massachusetts, Worcester (J.L.S.). Other authors were Stephen A. Spector, M.D. (University of California at San Diego Medical Center, San Diego), Clemente Diaz, M.D. (University of Puerto Rico, San Juan), James Rooney, M.D. (Glaxo Wellcome, Research Triangle Park, N.C.), James Balsley, M.D., Ph.D. (National Institute of Allergy and Infectious Diseases, Bethesda, Md.), Richard D. Gelber, Ph.D. (Harvard School of Public Health, Boston), and Edward M. Connor, M.D. (University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark).

Address reprint requests to Dr. Sperling at Mount Sinai Medical Center, Box 1173, 1 Gustave Levy Pl., New York, NY 10029.

Full Text of this Article

This article has been cited by other articles:

• Levison, J. (2008). The Ostrich Syndrome: Obstetrician Gynecologists and Human Immunodeficiency Virus Exposure. Obstet Gynecol 111: 183-186 [Abstract] [Full Text]  
• Chen, P., Hubner, W., Spinelli, M. A., Chen, B. K. (2007). Predominant Mode of Human Immunodeficiency Virus Transfer between T Cells Is Mediated by Sustained Env-Dependent Neutralization-Resistant Virological Synapses. J. Virol. 81: 12582-12595 [Abstract] [Full Text]  
• Divi, R. L., Leonard, S. L., Walker, B. L., Kuo, M. M., Shockley, M. E., St Claire, M. C., Nagashima, K., Harbaugh, S. W., Harbaugh, J. W., Poirier, M. C. (2007). Erythrocebus patas Monkey Offspring Exposed Perinatally to NRTIs Sustain Skeletal Muscle Mitochondrial Compromise at Birth and at 1 Year of Age. Toxicol Sci 99: 203-213 [Abstract] [Full Text]  
• Barreiro, P., Castilla, J. A., Labarga, P., Soriano, V. (2007). Is natural conception a valid option for HIV-serodiscordant couples?. Hum Reprod 22: 2353-2358 [Abstract] [Full Text]  
• Jayasuriya, A, Robertson, C, Allan, P S (2007). Twenty-five years of HIV management. JRSM 100: 363-366 [Full Text]  
• Hamlyn, E., Easterbrook, P. (2007). Occupational exposure to HIV and the use of post-exposure prophylaxis. Occup Med (Lond) 57: 329-336 [Abstract] [Full Text]  
• Thior, I., Lockman, S., Smeaton, L. M., Shapiro, R. L., Wester, C., Heymann, S. J., Gilbert, P. B., Stevens, L., Peter, T., Kim, S., van Widenfelt, E., Moffat, C., Ndase, P., Arimi, P., Kebaabetswe, P., Mazonde, P., Makhema, J., McIntosh, K., Novitsky, V., Lee, T.-H., Marlink, R., Lagakos, S., Essex, M., for the Mashi Study Team, (2006). Breastfeeding plus infant zidovudine prophylaxis for 6 months vs formula feeding plus infant zidovudine for 1 month to reduce mother-to-child HIV transmission in Botswana: a randomized trial: the Mashi Study.. JAMA 296: 794-805 [Abstract] [Full Text]  
• Correia, N. (2006). Specific Problems in Perinatal Infections: A Literature Review. Indoor and Built Environment 15: 25-28 [Abstract]  
• Omrani, A. S., Freedman, A. (2005). Prophylaxis of HIV infection. Br Med Bull 73-74: 93-105 [Abstract] [Full Text]  
• Shetty, A. K., Maldonado, Y. (2005). Advances in the Prevention of Perinatal HIV-1 Transmission. NeoReviews 6: e12-e25 [Full Text]  
• Chappuy, H., Treluyer, J.-M., Jullien, V., Dimet, J., Rey, E., Fouche, M., Firtion, G., Pons, G., Mandelbrot, L. (2004). Maternal-Fetal Transfer and Amniotic Fluid Accumulation of Nucleoside Analogue Reverse Transcriptase Inhibitors in Human Immunodeficiency Virus-Infected Pregnant Women. Antimicrob. Agents Chemother. 48: 4332-4336 [Abstract] [Full Text]  
• Lallemant, M., Jourdain, G., Le Coeur, S., Mary, J. Y., Ngo-Giang-Huong, N., Koetsawang, S., Kanshana, S., McIntosh, K., Thaineua, V., the Perinatal HIV Prevention Trial (Thailand) Inve, (2004). Single-Dose Perinatal Nevirapine plus Standard Zidovudine to Prevent Mother-to-Child Transmission of HIV-1 in Thailand. NEJM 351: 217-228 [Abstract] [Full Text]  
• Breese, P., Burman, W., Shlay, J., Guinn, D. (2004). The Effectiveness of a Verbal Opt-Out System for Human Immunodeficiency Virus Screening During Pregnancy. Obstet Gynecol 104: 134-137 [Abstract] [Full Text]  
• Spriggs, M, Charles, T (2003). Should HIV discordant couples have access to assisted reproductive technologies?. J. Med. Ethics 29: 325-329 [Abstract] [Full Text]  
• Ghosh, M. K., Kuhn, L., West, J., Semrau, K., Decker, D., Thea, D. M., Aldrovandi, G. M. (2003). Quantitation of Human Immunodeficiency Virus Type 1 in Breast Milk. J. Clin. Microbiol. 41: 2465-2470 [Abstract] [Full Text]  
• Newberry, Y., Kelsey, J. J. (2003). Mother to Child Transmission of HIV. Journal of Pharmacy Practice 16: 182-190 [Abstract]  
• DePAOLA, L. G. (2003). Managing the care of patients infected with bloodborne diseases. Journal of the American Dental Association 134: 350-358 [Abstract] [Full Text]  
• Gerberding, J. L. (2003). Occupational Exposure to HIV in Health Care Settings. NEJM 348: 826-833 [Full Text]  
• Thaker, H K, Snow, M H (2003). HIV viral suppression in the era of antiretroviral therapy. Postgrad. Med. J. 79: 36-42 [Abstract] [Full Text]  
• Revello, M. G., Gerna, G. (2002). Diagnosis and Management of Human Cytomegalovirus Infection in the Mother, Fetus, and Newborn Infant. Clin. Microbiol. Rev. 15: 680-715 [Abstract] [Full Text]  
• Dybul, M., Fauci, A. S., Bartlett, J. G., Kaplan, J. E., Pau, A. K. (2002). Guidelines for Using Antiretroviral Agents among HIV-Infected Adults and Adolescents: The Panel on Clinical Practices for Treatment of HIV. ANN INTERN MED 137: 381-433 [Abstract] [Full Text]  
• Von Tungeln, L. S., Hamilton, L. P., Dobrovolsky, V. N., Bishop, M. E., Shaddock, J. G., Heflich, R. H., Beland, F. A. (2002). Frequency of Tk and Hprt lymphocyte mutants and bone marrow micronuclei in B6C3F1/Tk+/- mice treated neonatally with zidovudine and lamivudine. Carcinogenesis 23: 1427-1432 [Abstract] [Full Text]  
• Watts, D. H. (2002). Management of Human Immunodeficiency Virus Infection in Pregnancy. NEJM 346: 1879-1891 [Full Text]  
• Berger, A., Preiser, W. (2002). Viral genome quantification as a tool for improving patient management: the example of HIV, HBV, HCV and CMV. J Antimicrob Chemother 49: 713-721 [Abstract] [Full Text]  
• Goodman, A., Penson, R. T., Blatman, R., McIntyre, J., Gioiella, M. E., Chabner, B. A., Lynch, T. J. Jr. (2002). A Staff Dialogue on a Socially Distanced Patient: Psychosocial Issues Faced by Patients, Their Families, and Caregivers. The Oncologist 7: 50-57 [Abstract] [Full Text]  
• Lagaye, S., Derrien, M., Menu, E., Coïto, C., Tresoldi, E., Mauclère, P., Scarlatti, G., Chaouat, G., Barré-Sinoussi, F., Bomsel, M., the European Network for the Study of In Utero Tra, (2001). Cell-to-Cell Contact Results in a Selective Translocation of Maternal Human Immunodeficiency Virus Type 1 Quasispecies across a Trophoblastic Barrier by both Transcytosis and Infection. J. Virol. 75: 4780-4791 [Abstract] [Full Text]  
• Mandelbrot, L., Landreau-Mascaro, A., Rekacewicz, C., Berrebi, A., Benifla, J. L., Burgard, M., Lachassine, E., Barret, B., Chaix, M.-L., Bongain, A., Ciraru-Vigneron, N., Crenn-Hebert, C., Delfraissy, J.-F., Rouzioux, C., Mayaux, M.-J., Blanche, S., for the Agence Nationale de Recherches sur le SIDA, (2001). Lamivudine-Zidovudine Combination for Prevention of Maternal-Infant Transmission of HIV-1. JAMA 285: 2083-2093 [Abstract] [Full Text]  
• Shaffer, N. (2001). Combination Prophylaxis for Prevention of Maternal-Infant HIV Transmission: Beyond 076. JAMA 285: 2129-2131 [Full Text]  
• Shetty, A. K., Maldonado, Y. (2001). Preventing Mother-to-Child Transmission of HIV-1: An International Perspective. NeoReviews 2: e75-82 [Full Text]  
• Shetty, A. K., Maldonado, Y. (2001). HIV transmission Prevention of Perinatal HIV-1 Transmission in the United States. NeoReviews 2: e83-93 [Full Text]  
• Dickover, R. E., Garratty, E. M., Plaeger, S., Bryson, Y. J. (2001). Perinatal Transmission of Major, Minor, and Multiple Maternal Human Immunodeficiency Virus Type 1 Variants In Utero and Intrapartum. J. Virol. 75: 2194-2203 [Abstract] [Full Text]  
• CHEN, K. T., SELL, R. L., TUOMALA, R. E. (2001). Cost-Effectiveness of Elective Cesarean Delivery in Human Immunodeficiency Virus-Infected Women. Obstet Gynecol 97: 161-168 [Abstract] [Full Text]  
• Mofenson, L. M., the Committee on Pediatric AIDS, (2000). Technical Report: Perinatal Human Immunodeficiency Virus Testing and Prevention of Transmission. Pediatrics 106: 88e-88 [Abstract] [Full Text]  
• McGowan, J. P., Shah, S. S. (2000). Prevention of perinatal HIV transmission during pregnancy. J Antimicrob Chemother 46: 657-668 [Abstract] [Full Text]  
• Lallemant, M., Jourdain, G., Le Coeur, S., Kim, S., Koetsawang, S., Comeau, A. M., Phoolcharoen, W., Essex, M., McIntosh, K., Vithayasai, V., The Perinatal HIV Prevention Trial (Thailand) Inve, (2000). A Trial of Shortened Zidovudine Regimens to Prevent Mother-to-Child Transmission of Human Immunodeficiency Virus Type 1. NEJM 343: 982-991 [Abstract] [Full Text]  
• Lo, Y.-R. J., Farley, T. M. M. (2000). Trends in Prevention of Mother-to-Child Transmission of HIV-1. Journal of Health Management 2: 201-218 [Abstract]  
• Beltrami, E. M., Williams, I. T., Shapiro, C. N., Chamberland, M. E. (2000). Risk and Management of Blood-Borne Infections in Health Care Workers. Clin. Microbiol. Rev. 13: 385-407 [Abstract] [Full Text]  
• Hirsch, M. S., Brun-Vezinet, F., D'Aquila, R. T., Hammer, S. M., Johnson, V. A., Kuritzkes, D. R., Loveday, C., Mellors, J. W., Clotet, B., Conway, B., Demeter, L. M., Vella, S., Jacobsen, D. M., Richman, D. D. (2000). Antiretroviral Drug Resistance Testing in Adult HIV-1 Infection: Recommendations of an International AIDS Society-USA Panel. JAMA 283: 2417-2426 [Abstract] [Full Text]  
• Bialkowska, A., Bialkowski, K., Gerschenson, M., Diwan, B. A., Jones, A. B., Olivero, O. A., Poirier, M. C., Anderson, L. M., Kasprzak, K. S., Sipowicz, M. A. (2000). Oxidative DNA damage in fetal tissues after transplacental exposure to 3'-azido-3'-deoxythymidine (AZT). Carcinogenesis 21: 1059-1062 [Abstract] [Full Text]  
• Quinn, T. C., Wawer, M. J., Sewankambo, N., Serwadda, D., Li, C., Wabwire-Mangen, F., Meehan, M. O., Lutalo, T., Gray, R. H., The Rakai Project Study Group, (2000). Viral Load and Heterosexual Transmission of Human Immunodeficiency Virus Type 1. NEJM 342: 921-929 [Abstract] [Full Text]  
• Tardieu, M., Le Chenadec, J., Persoz, A., Meyer, L., Blanche, S., Mayaux, M.-J. (2000). HIV-1-related encephalopathy in infants compared with children and adults. Neurology 54: 1089-1095 [Abstract] [Full Text]  
• Van Rompay, K. K. A., Miller, M. D., Marthas, M. L., Margot, N. A., Dailey, P. J., Canfield, D. R., Tarara, R. P., Cherrington, J. M., Aguirre, N. L., Bischofberger, N., Pedersen, N. C. (2000). Prophylactic and Therapeutic Benefits of Short-Term 9-[2-(R)-(Phosphonomethoxy)Propyl]Adenine (PMPA) Administration to Newborn Macaques following Oral Inoculation with Simian Immunodeficiency Virus with Reduced Susceptibility to PMPA. J. Virol. 74: 1767-1774 [Abstract] [Full Text]  
• de Zulueta, P. (2000). The ethics of anonymised HIV testing of pregnant women: a reappraisal. J. Med. Ethics 26: 16-21 [Abstract] [Full Text]  
• SHAPIRO, D. E., SPERLING, R. S., MANDELBROT, L., BRITTO, P., CUNNINGHAM, B. E. (1999). Risk Factors for Perinatal Human Immunodeficiency Virus Transmission in Patients Receiving Zidovudine Prophylaxis. Obstet Gynecol 94: 897-908 [Abstract] [Full Text]  
• (1999). Prevention of Perinatal HIV Infection: Cause For Optimism. AIDS Clin Care 1999: 1-1 [Full Text]  
• Ioannidis, J. P.A., Contopoulos-Ioannidis, D. G., Mofenson, L. M., Lambert, J. S., Stiehm, E. R., Garcia, P. M., Moye, J., Lew, J. F. (1999). Maternal Viral Load and the Risk of Perinatal Transmission of HIV-1. NEJM 341: 1698-1700 [Full Text]  
• Lindegren, M. L., Byers, R. H. Jr, Thomas, P., Davis, S. F., Caldwell, B., Rogers, M., Gwinn, M., Ward, J. W., Fleming, P. L. (1999). Trends in Perinatal Transmission of HIV/AIDS in the United States. JAMA 282: 531-538 [Abstract] [Full Text]  
• Mofenson, L. M., Lambert, J. S., Stiehm, E. R., Bethel, J., Meyer, W. A., Whitehouse, J., Moye, J., Reichelderfer, P., Harris, D. R., Fowler, M. G., Mathieson, B. J., Nemo, G. J., The Pediatric AIDS Clinical Trials Group Study 185, (1999). Risk Factors for Perinatal Transmission of Human Immunodeficiency Virus Type 1 in Women Treated with Zidovudine. NEJM 341: 385-393 [Abstract] [Full Text]  
• Garcia, P. M., Kalish, L. A., Pitt, J., Minkoff, H., Quinn, T. C., Burchett, S. K., Kornegay, J., Jackson, B., Moye, J., Hanson, C., Zorrilla, C., Lew, J. F., The Women and Infants Transmission Study Group, (1999). Maternal Levels of Plasma Human Immunodeficiency Virus Type 1 RNA and the Risk of Perinatal Transmission. NEJM 341: 394-402 [Abstract] [Full Text]  
• Kashuba, A. D. M., Dyer, J. R., Kramer, L. M., Raasch, R. H., Eron, J. J., Cohen, M. S. (1999). Antiretroviral-Drug Concentrations in Semen: Implications for Sexual Transmission of Human Immunodeficiency Virus Type 1. Antimicrob. Agents Chemother. 43: 1817-1826 [Full Text]  
• Wilson, C. C., Brown, R. C., Korber, B. T., Wilkes, B. M., Ruhl, D. J., Sakamoto, D., Kunstman, K., Luzuriaga, K., Hanson, I. C., Widmayer, S. M., Wiznia, A., Clapp, S., Ammann, A. J., Koup, R. A., Wolinsky, S. M., Walker, B. D., The Ariel Project Investigators, (1999). Frequent Detection of Escape from Cytotoxic T-Lymphocyte Recognition in Perinatal Human Immunodeficiency Virus (HIV) Type 1 Transmission: the Ariel Project for the Prevention of Transmission of HIV from Mother to Infant. J. Virol. 73: 3975-3985 [Abstract] [Full Text]  
• Henderson, D. K. (1999). Postexposure Chemoprophylaxis for Occupational Exposures to the Human Immunodeficiency Virus. JAMA 281: 931-936 [Full Text]  
• Lurie, P., Miller, S., Hecht, F., Chesney, M., Lo, B. (1998). Postexposure Prophylaxis After Nonoccupational HIV Exposure: Clinical, Ethical, and Policy Considerations. JAMA 280: 1769-1773 [Abstract] [Full Text]  
• McIntosh, K. (1998). Short (And Shorter) Courses of Zidovudine. NEJM 339: 1467-1468 [Full Text]  
• Mofenson, L. M. (1998). Perinatal Transmission of HIV in Women Receiving Zidovudine: Abstract and Commentary. JAMA 280: 569-570 [Full Text]  
• Luzuriaga, K., Sullivan, J. L. (1998). Prevention and Treatment of Pediatric HIV Infection. JAMA 280: 17-18 [Full Text]  
• Mandelbrot, L., Le Chenadec, J., Berrebi, A., Bongain, A., Benifla, J.-L., Delfraissy, J.-F., Blanche, S., Mayaux, M.-J., for the French Perinatal Cohort, (1998). Perinatal HIV-1 Transmission: Interaction Between Zidovudine Prophylaxis and Mode of Delivery in the French Perinatal Cohort. JAMA 280: 55-60 [Abstract] [Full Text]  
• Wainberg, M. A., Friedland, G. (1998). Public Health Implications of Antiretroviral Therapy and HIV Drug Resistance. JAMA 279: 1977-1983 [Abstract] [Full Text]  
• Minkoff, H., O'Sullivan, M. J. (1998). The Case for Rapid HIV Testing During Labor. JAMA 279: 1743-1744 [Full Text]  
• Lew, J., Reichelderfer, P., Fowler, M., Bremer, J., Carrol, R., Cassol, S., Chernoff, D., Coombs, R., Cronin, M., Dickover, R., Fiscus, S., Herman, S., Jackson, B., Kornegay, J., Kovacs, A., McIntosh, K., Meyer, W., Michael, N., Mofenson, L., Moye, J., Quinn, T., Robb, M., Vahey, M., Weiser, B., Yeghiazarian, T. (1998). Determinations of Levels of Human Immunodeficiency Virus Type 1 RNA in Plasma: Reassessment of Parameters Affecting Assay Outcome. J. Clin. Microbiol. 36: 1471-1479 [Full Text]  
• Tuntland, T., Odinecs, A., Nosbisch, C., Unadkat, J. D. (1998). In Vivo Maternal-Fetal-Amniotic Fluid Pharmacokinetics of Zidovudine in the Pigtailed Macaque: Comparison of Steady-State and Single-Dose Regimens. J. Pharmacol. Exp. Ther. 285: 54-62 [Abstract] [Full Text]  
• Simpson, W. M, Johnstone, F. D, Boyd, F. M, Goldberg, D. J, Hart, G. J, Prescott, R. J (1998). Uptake and acceptability of antenatal HIV testing: randomised controlled trial of different methods of offering the test. BMJ 316: 262-267 [Abstract] [Full Text]  
• Lyall, E G H., Stainsby, C., Taylor, G. P, Ait-Khaled, M., Bingham, S., Evans, J. A, Wright, A., Weber, J. N, McClure, M. O, Walters, S., Tudor-Williams, G. (1998). Review of uptake of interventions to reduce mother to child transmission of HIV by women aware of their HIV status. BMJ 316: 268-270 [Abstract] [Full Text]  
• Brambilla, D, Leung, S, Lew, J, Todd, J, Herman, S, Cronin, M, Shapiro, D., Bremer, J, Hanson, C, Hillyer, G., McSherry, G., Sperling, R., Coombs, R., Reichelderfer, P. (1998). Absolute copy number and relative change in determinations of human immunodeficiency virus type 1 RNA in plasma: effect of an external standard on kit comparisons [In Process Citation]. J. Clin. Microbiol. 36: 311-314 [Abstract] [Full Text]  
• Cardo, D. M., Culver, D. H., Ciesielski, C. A., Srivastava, P. U., Marcus, R., Abiteboul, D., Heptonstall, J., Ippolito, G., Lot, F., McKibben, P. S., Bell, D. M., The Centers for Disease Control and Prevention Nee, (1997). A Case-Control Study of HIV Seroconversion in Health Care Workers after Percutaneous Exposure. NEJM 337: 1485-1490 [Abstract] [Full Text]  
• Henderson, D. K. (1997). Postexposure Treatment of HIV -- Taking Some Risks for Safety's Sake. NEJM 337: 1542-1543 [Full Text]  
• Cournos, F., Bakalar, N., Rotheram-Borus, M. J. (1997). Mandatory HIV Testing for the Mentally Ill. NEJM 337: 1014-1015 [Full Text]  
• Lurie, P., Wolfe, S. M. (1997). Unethical Trials of Interventions to Reduce Perinatal Transmission of the Human Immunodeficiency Virus in Developing Countries. NEJM 337: 853-856 [Full Text]  
• (1997). Major advances in the treatment of HIV-1 infection. DTB 35: 25-29 [Abstract] [Full Text]  
• SHARLAND, M., GIBB, D., TUDOR-WILLIAMS, G., WALTERS, S., NOVELLI, V. (1997). Paediatric HIV infection. Arch. Dis. Child. 76: 293-296 [Full Text]  
• (1997). Maternal Viral Load and Perinatal Transmission. AIDS Clin Care 1997: 2-2 [Full Text]  
• (1997). AZT Curbs Mother-Infant HIV Transmission at All Viral Loads and CD4 Counts. JWatch Women's Health 1997: 11-11 [Full Text]  
• Wilfert, C. M. (1996). Beginning to Make Progress against HIV. NEJM 335: 1678-1680 [Full Text]