First-lineRetrovir
Zidovudine (AZT)
Nucleoside reverse transcriptase inhibitor
Intrapartum IV in HIV with VL >1000 — PMTCT.
OralIV
First-line for
- Intrapartum prophylaxis if HIV VL >1000 c/mL
- Neonatal post-exposure prophylaxis
Mechanism
Phosphorylated to ZDV-TP → competitive RT inhibitor + chain terminator.
AZT triad
- A — ART antenatally (cART regimen)
- Z — ZDV IV in labour (if VL>1000)
- T — Treat baby post-natally
Dosing
- Intrapartum
- 2 mg/kg IV load → 1 mg/kg/h infusion until cord clamping
- Neonatal
- 4 mg/kg PO BD ×2–4 w
Contraindications
- CautionSevere anaemia / neutropenia
Side effects
- Anaemia, neutropenia
- Headache, myopathy
- Lactic acidosis
Fetal & maternal notes
- • Reduces vertical transmission to <1% with full ART.
- • Avoid BF if alternative safe feeding available.
Key interactions
Ribavirin
AvoidAnaemia
Ganciclovir
AvoidMarrow toxicity
Clinical pearls
- 💡 Elective LSCS at 38–39/40 if VL >50.
- 💡 Continue maternal cART always.
Content last reviewed: REPLACE_ME (e.g. 2026-07)
Spotted something out of date? See our disclaimer or use Report an Error above.