Antiretroviral Therapy in HIV-infected Pregnant Women |
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| Affiliation: | 1. Department of Emergency Medicine Ghent University Hospital, Faculty of Medicine UG, Ghent, Belgium;2. EMS Dispatch Center, East & West Flanders, Federal Department of Health, Belgium;3. Paediatric Cardiac Anesthesiology, Wilhelmina Children''s Hospital, University Medical Center, Utrecht, Netherlands;4. Paediatric Intensive Care Unit, NH Hospital, Hořovice, Czech Republic;5. Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Medical Faculty of Masaryk University, Brno, Czech Republic;6. SAMUR – Protección Civil, Madrid, Spain;7. Department of Paediatrics and Emergency Medicine, Hospital de Terassa, Consorci Sanitari de Terrassa, Barcelona, Spain;8. Paediatric Intensive Care & Emergency Department, Hôpital Universitaire des Enfants, Université Libre de Bruxelles, Brussels, Belgium;9. Hon. Consultant Paediatric Anaesthetist, Great Ormond Street Hospital for Children, London, UK;10. Réanimation et Surveillance Continue Pédiatriques et Néonatales, CHU Pellegrin – Hôpital des Enfants de Bordeaux, Université de Bordeaux, Bordeaux, France;11. Paediatric Intensive Care and Emergency Medicine, Dr. von Hauner Children''s Hospital, Ludwig-Maximilians-University, Munich, Germany;12. Paediatric gastroenterology, Akureyri Hospital, Akureyri, Iceland;13. Paediatric Anaesthesia, The Juliane Marie Centre, University Hospital of Copenhagen, Copenhagen, Denmark;14. Paediatric Emergency Medicine, Imperial College Healthcare Trust NHS, Faculty of Medicine Imperial College, London, UK;1. Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland;2. Department of Paediatrics, Tampere University Hospital, Tampere, Finland;3. Geneva, Switzerland;4. Sight and Life, Kaiseraugst, Switzerland;5. Indian Council for Medical Research, New Delhi, India;6. Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA;7. Paul H Nitze School of Advanced International Studies, Johns Hopkins University, Baltimore, MD, USA;8. United Nations Children''s Fund, New York, NY, USA;9. Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children''s Hospital, Boston, MA, USA;10. Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana;11. Effective Care Research Unit, University of the Witwatersrand, Johannesburg, South Africa;12. Department of Obstetrics and Gynaecology, Walter Sisulu University, East London, South Africa;13. Nuffield Department of Women''s and Reproductive Health, University of Oxford, Oxford, UK;14. UCL Great Ormond Street Institute of Child Health, University College London, London, UK;15. Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK;p. Condon, MT, USA;q. Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya;1. Erasmus SYNC Lab, the Netherlands;2. Erasmus School of Social and Behavioral Sciences, Erasmus University Rotterdam, the Netherlands;3. Brain and Development Research Center, the Netherlands;4. Leiden Institute for Brain and Cognition, the Netherlands;5. Great Lakes Neurobehavioral Center, Edina, MN, United States;1. Department of Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt;2. Department of Dermatology, Venerology and Andrology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt;3. Department of Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt;1. Division of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, affiliated with Cincinnati University, Cincinnati, OH;2. Department of Orthopaedic Surgery, Meir Medical Center, Kfar Saba, affiliated with Tel Aviv University, Tel Aviv, Israel |
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| Abstract: | The use of antiretroviral therapy in pregnancy has changed dramatically in the past five years. This article reviews these developments. The use of zidovudine monotherapy in pregnancy, during delivery and given post-natally to the infant for the reduction of maternal-infant transmission has been evaluated. In a placebo-controlled double-blinded method, a significant reduction in maternal-infant transmission, from 25 to eight percent, was found. Triple antiretrovirals with newer agents from different drug families are now recommended as the optimal therapy for adults. Therapy is directed by the adults HIV viral load and by their CD4 count as measures of viral activity and immune compromise, respectively. Given these changes in adult therapy, treatment of the pregnant woman is undergoing re-evaluation. It is now considered to be in the best interest of the mother to consider full triple antiretroviral therapy during pregnancy or to continue antiretroviral therapy if pregnancy occurs while a woman is taking this treatment. It is of great concern that there is minimal information about the safety of these drugs used during pregnancy. A review of each of the currently available antiretroviral drugs in pregnancy is presented here. It is strongly recommended that any health care provider caring for an HIV-infected pregnant woman, or an HIV-infected woman who could become pregnant, be aware of the issues and concerns around combination antiretrovirals in pregnancy. Consultation with experts in this area is recommended. |
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| Keywords: | Pregnancy HIV AIDS antiretrovirals |
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