AIDS antiretroviral therapy in pregnancy: Difference between revisions
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*Reduction of perinatal transmission of infection. | *Reduction of perinatal transmission of infection. | ||
*Treatment of maternal HIV disease. | *Treatment of maternal HIV disease. | ||
==ART Regimen== | |||
==Counselling== | ==Counselling== | ||
Pregnant women who are HIV-infected should be counseled concerning their options (either on-site or by referral), given appropriate antenatal treatment, and advised not to breastfeed their infants. | Pregnant women who are HIV-infected should be counseled concerning their options (either on-site or by referral), given appropriate antenatal treatment, and advised not to breastfeed their infants. | ||
Revision as of 20:14, 22 February 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editors-in-Chief: Ujjwal Rastogi, MBBS [2]
Overview
The risk of HIV transmission from mother to infant had declined to low levels with the use of ART in USA and Europe. The risk for perinatal HIV transmission can be reduced to <2% through the use of antiretroviral regimens and obstetrical interventions (i.e., zidovudine or nevirapine and elective cesarean section at 38 weeks of pregnancy) and by avoiding breastfeeding.[1]
Therapeutic Goals
- Reduction of perinatal transmission of infection.
- Treatment of maternal HIV disease.
ART Regimen
Counselling
Pregnant women who are HIV-infected should be counseled concerning their options (either on-site or by referral), given appropriate antenatal treatment, and advised not to breastfeed their infants.
WHO Recommendations
- All pregnant women who require therapy for their own health should receive a combination antepartum antiretroviral (ART) drug regimen containing at least three drugs for treatment, which will also reduce the risk of perinatal transmission.
- Combination antepartum drug regimens are also recommended for prevention of perinatal transmission in women who do not yet require therapy for their own health.
- ART prophylaxis is more effective when given for a longer than a shorter duration. Therefore, ART drugs should be started as soon as possible in women who require treatment for their own health (AI), and without delay after the first trimester in women who do not require immediate initiation of therapy for their own health, although earlier initiation can be considered in these women as well.
- In the absence of antepartum administration of ART drugs, ART drugs should be administered intrapartum in combination with infant ART prophylaxis to reduce the risk of perinatal transmission (AI); if antepartum and intrapartum ART drugs are not received, infant ART prophylaxis should be provided (see Infant Antiretroviral Prophylaxis) (AI).
- Adding single-dose intrapartum/newborn nevirapine to the standard antepartum combination ART regimens used for prophylaxis or treatment in pregnant women in the United States is not recommended. This is because the drug does not appear to provide additional efficacy in reducing transmission and it may be associated with development of nevirapine resistance (AI).
- Breastfeeding is not recommended for HIV-infected women in the United States—including those receiving combination antiretroviral therapy (ART)—because safe, affordable, and feasible alternatives are available (AII).
Reference
- ↑ Bulterys M, Weidle PJ, Abrams EJ, Fowler MG (2005). "Combination antiretroviral therapy in african nursing mothers and drug exposure in their infants: new pharmacokinetic and virologic findings". J. Infect. Dis. 192 (5): 709–12. doi:10.1086/432490. PMID 16088819. Retrieved 2012-02-22. Unknown parameter
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