Patients with HIV who desire or have indications for diagnostic testing during pregnancy (e.g., abnormal ultrasound or aneuploidy screening) should be counselled about the potential risk of perinatal HIV transmission, along with other risks of the procedure, so that they can make informed decisions about invasive testing. Although the data on women who are receiving …
HIV viral load More frequent HIV viral load monitoring is recommended in pregnant women with HIV infection to ensure rapid and sustained virological suppression has been achieved. HIV viral load should be assessed at the initial visit, 2 – 4 weeks after initiating or changing ART, monthly until undetectable, and at least 3 monthly thereafter. …
Monitoring of HIV-infected women during 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 …
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 …
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 »
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 »
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 …
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, …
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] …
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] …