How safe is the use of AZT in the fight against HIV especially for HIV positive mothers?

I have come across information to the fact that AZT is no longer in use in the USA yet in South Africa it is still being used to reduce mother to child HIV transmission. I would like to hear from scientifically informed people on the efficacy of this policy choice.

Violetki is right on the money.

Zidovudine (AZT) is probably the most common HIV med used in the prevention of mother to child transmission in North America.

We have mountains of data on AZT (probably more than other meds because it has been around and in use for longer than the others). AZT is one of the most thouroughly studied antiretroviral drugs during pregnancy with proven efficacy in reducing mother to child transmission

It is still used because it not only reduces the amount of virus in the blood ( viral load ) -- the main purpose of HIV meds --but it also seems to have a positive effect beyond just reducing the mothers viral load. It readily crosses the placental barrier and therefore provides protection to the fetus in the womb and protection as it comes into contact with the mom's genital secretions and blood during vaginal delivery.

AZT is a drug that should be part of a pregnant mom's HIV regimen starting around 12-14 weeks gestation (obviously individual risk/benefit analysis should be undertaken before starting a pregnant mom on any drug), almost always in combination as was mentioned above. And given intravenously when she presents in labour or when her membranes rupture.

Results of respectable studies suggest that while starting AZT prior to labour provides the best protection, starting it when the mother goes into labour or shortly after the baby is delivered still provides some benefit to the baby.

For women who present in labour (with no prenatal care / no HIV meds during gestation) Nevirapine, another HIV drug, is probably the most effective choice (however there are some possible restrictions to its use depending on the mother's stage of disease). There are many concerns about single dose nevirapine when a woman presents in labour and so should probably only be used when a mom's viral load has not been suppressed prior to delivery, or when IV AZT is not available and should ideally only be used when in combination with AZT and 3TC to prevent resistance from occuring.

So, bottom line, AZT is still the front line drug to be used in pregnant women who receive HIV drugs well before delivery and still one of the top choices for women who present in labour with no history of treatment and high viral loads.

AZT is still used there because it is inexpensive, it is not nearly as effective as the new drugs available here, but it is better than nothing at all.

You are misinformed. AZT is still used in the US in pregnant women that are HIV+ to PREVENT transmission to the baby. It is very effective in reducing transmission to the baby. Actually it is the standard of care here in the US to prevent transmission to the baby.

AZT is safe in the short-term for moms and the baby can get a mild anemia which goes away later.
As far as long-term safety- we don't know the full story yet because it hasn't been used long enough. But so far it seems to be safe in the baby.

As far as treating the HIV+ woman while she is pregnant, AZT may not be enough and you may have to combine it with other HIV drugs that are ok to use in pregnancy.

Now as far as using AZT to TREAT HIV in men and nonpregnant women --that's a whole other story.