perinatal transmission of HIV
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Etiology
- HIV1 transmission may occur
- in utero, at delivery, or during breast feeding
Laboratory
- HIV testing of all women early in pregnancy is recommended[2]
- secondary testing of high risk women during the 3rd trimester of pregnancy may be cost-effective[2]
Management
- treatment of HIV+ women in the 2nd & 3rd trimester of pregnancy reduces risk of vertical transmission by 67%
- zidovudine (AZT) should be administered to women near delivery if viral load exceeds >1000 copies/mL or is unknown[5]
- zidovudine continuous infusion during labor
- HIV-exposed neonates should receive AZT for 4-6 weeks, with nevirapine added in the first few days of life if maternal infection is uncontrolled[5]
- AZT 2 mg/kg every 6 hours for 6 weeks
- single dose intrapartum nevirapine reduces risk of perinatal HUV transmission by 40%[3]
- addition of single dose tenofovir & emtricitabine to nevirapine reduces risk of drug-resistant viral mutations[4]
- HIV+ women should NOT breast feed their infants; use formula
- delivery by cesarean section does NOT prevent vertical transmission of HIV
More general terms
Additional terms
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ 2.0 2.1 2.2 Journal Watch 24(1):10, 2004 Sansom SL et al, Obstet Gynecol 102:782, 2003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14551009
- ↑ 3.0 3.1 Jackson JB et al, Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: 18 month follow-up to the HIVNET 012 randomised trial. Lancet 2003, 362:859 PMID: https://www.ncbi.nlm.nih.gov/pubmed/13678973
- ↑ 4.0 4.1 Chi BH et al, Single dose tenofovir and emtricitabine for reduction of viral resistance to non-nucleoside reverse transcriptase inhibitor drugs in women given intrapartum nevirapine for perinatal HIV prevention: An open-label randomised trial. Lancet 2007, 370:1698 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/17997151 <Internet> http:///dx.doi.org/10.1016/S0140-6736(07)61605-5
- ↑ 5.0 5.1 5.2 Zuger A Use of Antiretroviral Drugs in Pregnancy. Physician's First Watch, April 22, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and interventions to reduce perinatal HIV transmission in the United States. 2014. AIDSinfo. Clinical Guidelines Portal. March 28, 2014. http://aidsinfo.nih.gov/Guidelines/HTML/3/perinatal-guidelines/0 (corresponding NGC guideline withdrawn March 2016)