HIV infection during pregnancy
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Management
- pregnant women with HIV should be started on antiretroviral treatment regardless or CD4 count or not they have clinical symptoms.
- all patients should have access to CD4 testing & routine viral load monitoring.
- antiretroviral prophylaxis during pregnancy can reduce the risk of transmission to the infant[3]
- see acquired immunodeficiency syndrome for antiretroviral regimens
- zidovudine, lamivudine & lopinavir/ritonavir may be the preferred combination during pregnancy
- nucleoside reverse transcriptase inhibitor options
- tenofovir, abacavir, zidovudine[6]
- tenofovir disoproxil fumarate safe
- tenofovir alafenamide not recommended[4]
- tenofovir, abacavir, zidovudine[6]
- antiretroviral protease inhibitor options
- efavirenz
- not teratogenic[4]
- may be continued in women who become pregnant[6]
- nevirapine
- may be continued in pregant women doing well
- should not be initiated in pregnant women with CD4 counts >250 cells/mm3 or liver disease[6]
- too little experience with etravirine or rilpivirine
- raltegravir may be considered as an alternative agent
- dolutegravir, elvitegravir, enfuvirtide & maraviroc, bictegravir, & tenofovir alafenamide are not recommended because of a lack of safety data[4][6]
- avoid dolutegravir in 1st 8 weeks[4]
- tenofovir-emtricitabine should not be a 1st treatment choice[9]
- coinfection with hepatitis B may be indication for tenofovir-emtricitabine[9]
- zidovudine + lamivudine[9]
- zidovudine (AZT) should be administered to women near delivery if viral load exceeds >1000 copies/mL or is unknown[6]
- 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[6]
Notes
- postpartum maternal viral suppression in women diagnosed with HIV1 infection during pregnancy is < 50%[7]
- 13% do not receive HIV-related care until after delivery
- 40% have <=1 viral load test within 1 year of delivery[7]
More general terms
Additional terms
References
- ↑ AIDS info: US Department of Health and Human Services AIDSinfo: http://aidsinfo.nih.gov
- ↑ Public Health Service Task Force Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission in the United States July 6, 2006 http://aidsinfo.nih.gov/ContentFiles/PerinatalGL.pdf (corresponding NGC guideline withdrawn March 2016)
- ↑ Jump up to: 3.0 3.1 Use of antiretroviral drugs for treating pregnant women and preventing HIV Infection in infants World Health Organization Nov. 2009 http://www.who.int/hiv/pub/mtct/rapid_advice_mtct.pdf corresponding NGC guideline withdrawn Feb 2016
- ↑ Jump up to: 4.0 4.1 4.2 4.3 4.4 Medical Knowledge Self Assessment Program (MKSAP) 16, 18, 19. American College of Physicians, Philadelphia 2012, 2018, 2021.
- ↑ Thompson MA et al. Antiretroviral treatment of adult HIV infection: 2012 recommendations of the International Antiviral Society - USA panel. JAMA 2012 Jul 25 ; 308:387. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22820792 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1221704
- ↑ Jump up to: 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 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) - ↑ Jump up to: 7.0 7.1 7.2 Swain CA, Smith LC, Nash D et al. Postpartum human immunodeficiency virus care among women diagnosed during pregnancy. Obstet Gynecol 2016 Jul; 128:44 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27275796
- ↑ AIDSinfo: Maternal-Child Transmission http://aidsinfo.nih.gov/guidelines/default_db2.asp?id=66
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. http://aidsinfo.nih.gov/contentfiles/PerinatalGL.pdf (corresponding NGC guideline withdrawn March 2016) - ↑ Jump up to: 9.0 9.1 9.2 9.3 Young K, Fairchild DG, Hefner JE New Guidelines Issued on HIV Treatment During Pregnancy. Physician's First Watch, Sept 12,2017 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org