One of the greatest advances in the management of HIV
infection has been in pregnant women. Prior toantiviral therapy, the
risk of HIV transmission from an infected mother to hernewborn
was approximately 25-35%.
The first major advance in this area came with studies
giving ZDV after thefirst trimester of pregnancy, then intravenously during the
delivery process,and then after delivery to the newborn for 6 weeks. This
treatment showed areduction in the risk of transmission to less than 10%.
Although less data areavailable with more potent drug combinations, clinical
experience suggests thatthe risk of transmission may be reduced to less than
5%.
Current recommendations are to advise HIV-infected pregnant women regardingboth the unknown side effects of antiviral therapy on the fetus, and thepromising clinical experience with potent therapy in preventing transmission.
In the final analysis, however, pregnant women with HIV should be treatedessentially the same as non-pregnant women with HIV. Exceptions would be duringthe first trimester, where therapy remains controversial, and avoiding certaindrugs that may cause greater concern for fetal toxicity, such as EFV.
All HIV-infected pregnant women should be managed by an obstetrician withexperience in dealing with HIV-infected women. Maximal obstetric precautions tominimize transmission of the HIV virus such as avoiding scalp monitors, andminimizing labor after rupture of the uterine membranes.
The potential use of an elective Caesarean section ( C- section ) should bediscussed, particularly in those women without good viral control of their HIVinfection where the risk of transmission may be increased.
Breastfeeding should be avoidedif alternative nutrition for the infant is available since HIV transmission canoccur by this route. Despite the reduced risk of transmission associated withantiviral therapy, pregnant women with HIV need to be thoroughly counseledregarding all risks, as well as all options, including therapeutic abortionswhen appropriate.
Current recommendations are to advise HIV-infected pregnant women regardingboth the unknown side effects of antiviral therapy on the fetus, and thepromising clinical experience with potent therapy in preventing transmission.
In the final analysis, however, pregnant women with HIV should be treatedessentially the same as non-pregnant women with HIV. Exceptions would be duringthe first trimester, where therapy remains controversial, and avoiding certaindrugs that may cause greater concern for fetal toxicity, such as EFV.
All HIV-infected pregnant women should be managed by an obstetrician withexperience in dealing with HIV-infected women. Maximal obstetric precautions tominimize transmission of the HIV virus such as avoiding scalp monitors, andminimizing labor after rupture of the uterine membranes.
The potential use of an elective Caesarean section ( C- section ) should bediscussed, particularly in those women without good viral control of their HIVinfection where the risk of transmission may be increased.
Breastfeeding should be avoidedif alternative nutrition for the infant is available since HIV transmission canoccur by this route. Despite the reduced risk of transmission associated withantiviral therapy, pregnant women with HIV need to be thoroughly counseledregarding all risks, as well as all options, including therapeutic abortionswhen appropriate.
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