Pregnancy and reproductive health in women with HIV infection

Virginia Furner The Albion Centre, Sydney, NSW Women with human immunodeficiency virus (HIV) infection in Australia are now choosing pregnancy as a proactive, positive, reproductive option. In addition, some women will be initially diagnosed as having HIV infection during a pregnancy. All with HIV women should have access to all the recommended strategies to prevent …

Pregnancy and reproductive health in women with HIV infection Read More »

The National HIV Testing Policy recommends that all pregnant women should be routinely offered HIV testing. This should be performed with pre-test discussion, preferably at the first antenatal visit.[2] The risk of perinatal transmission of HIV can be significantly reduced by a number of established evidence-based antenatal and postnatal interventions and appropriate care throughout the …

HIV testing in pregnancy – a priority Read More »

Routine reproductive counselling is essential for all women with HIV infection. [3] In a survey of 700 women with HIV infection in 2011, 22% of whom became pregnant after an HIV diagnosis, 58% had never discussed pregnancy or treatment options before pregnancy and 42% had limited or no knowledge of antiretroviral therapy (ART) options. [4] …

Conception counselling Read More »

Previous studies have indicated that one in five women with HIV infection are not using any contraceptive method, a rate which is higher than in the general population. High rates of unintended pregnancies have been reported in some settings with proportions ranging from 50-85%, with condoms often being the most commonly used contraceptive method. [5] …

Contraception Read More »

The first major study of HIV prevention in pregnancy was the Paediatric AIDS Clinical Trials PACTG 076 in 1994. This placebo-controlled study demonstrated that the administration of zidovudine to pregnant women and their infants could reduce the risk of perinatal HIV transmission by 67.5% overall.[1]0, 11] More recent studies have explored the efficacy of shorter, …

Prevention of mother-to-child transmission Read More »

Antiretroviral drugs for prevention of perinatal transmission of HIV are recommended for all pregnant women, regardless of CD4+ T cell counts and HIV viral load, and will reduce perinatal transmission through a number of mechanisms. Antenatal drug administration decreases maternal HIV viral load in blood and genital secretions. A number of studies have shown that …

Principles of antiretroviral use in pregnancy Read More »

Current recommendations for specific antiretroviral drugs are available in existing guidelines (USA and UK). [9, 30] Preferred antiretroviral drugs are those with clinical trial data in adults that have demonstrated: Optimal efficacy and durability Acceptable toxicity and ease of use Pregnancy-specific pharmacokinetic (PK) data available to guide dosing No associated teratogenic effects No reported maternal, …

Recommendations for the use of antiretroviral drugs in pregnancy Read More »

Several pregnancy-specific issues will need special consideration when using ART in pregnant women. These include the efficacy of antiretroviral drugs in prevention of mother-to-child HIV transmission, maternal and foetal toxicity, teratogenicity, PK profile, antiretroviral drug resistance testing before and during pregnancy, transplacental transfer of antiretroviral drugs, timing of treatment initiation, hyperemesis and nausea of pregnancy. …

Special issues when using antiretroviral therapy in pregnancy Read More »

The following section is included in detail to highlight the changing safety status of newly introduced antiretroviral drugs and how ART guidelines will reflect the currently available data as more women and infants are exposed in pregnancy. Dolutegravir Botswana embarked upon a birth outcome surveillance programme in 2014. In 2018, the Tsepamo Study in Botswana …

Specific drug safety issues in pregnancy Read More »

Early and more recent data are conflicting in regard to whether ART during pregnancy is associated with adverse pregnancy outcomes, specifically with preterm delivery (before 37 weeks). Multiple observational studies have detected small but significant increases in preterm birth with PI-based and non PI-based ART. [40, 41] Conflicting findings may be influenced by a number …

Preterm delivery Read More »