Guidelines for the management of HIV infection in pregnant women and the prevention of mother‐to‐child transmission

Abstract

Aims of the guidelines These guidelines, drawn up by a multidisciplinary group of clinicians and lay workers active in the management of pregnant women infected with HIV, aim to give up‐to‐date information on interventions to reduce the risk of mother to child transmission of the virus. The evidence on the use of interventions to prevent mother to child transmission of HIV has been graded according to the strength of the data as per the definitions of the US Agency for Health Care Policy and Research [1]. Weighted evidence on the use of combination antiretroviral therapy (ART) for the treatment of HIV infection per se is presented in the BHIVA guidelines for adults [2,3]. The highest level evidence (i.e. randomised controlled trials (RCTs) or large, well conducted meta‐analyses) is only available for formula feeding, prelabour caesarean section and zidovudine monotherapy. The need to treat mothers for HIV infection has led to the widespread use of ART in pregnancy which in turn results in new questions such as how to deliver when the mother, on therapy, has no detectable plasma viraemia with the most sensitive assays. In addressing many common and/or difficult clinical scenarios in the absence of ‘best evidence’ the guidelines rely heavily on ‘expert opinion’. Recommendations for management are given in the section on clinical scenarios, and summarized in Table 3. An expanded version of these guidelines with an appendix on safety and toxicity data is available on the BHIVA website http://www.bhiva.org. The authors are available to discuss individual cases.

Adrenal Enzyme Impairment in Neonates and Adolescents Treated with Ritonavir and Protease Inhibitors for HIV Exposure or Infection

“…In neonates who are at very high risk due to suboptimal or absence of treatment in the mother, combination antiretroviral drug therapy is used. Ritonavir-boosted protease inhibitor (r-PI) therapy was widely used in this situation [1,2,3,4,5] until a 2011 warning from the FDA about potential hazards in neonates, particularly those born prematurely [6]. After the neonatal period, r-PI-based combinations are often given for first-line or subsequent treatment.…”

A Paradigm Shift in the Epidemiology of HIV in Pregnancy at ICTC of a Medical College

“…Cafeteria approach strategies will benefit our patients as such an offer given freedom to accept the programme than a prescribed and the protocol contrast to the existing informed choice and consent. Optimization of labor by avoiding prolonged labor, PROM and taking the advantage of cesarean delivery compared to vaginal delivery [9]. RCOG recommend LSCS for all HIV positive mother [1,000 copies of virus/ ml [10].…”

A pilot study to evaluate the safety and feasibility of the administration of AZT/3TC fixed dose combination to HIV infected pregnant women and their infants in Rio de Janeiro, Brazil

“…9 Since 1997, the British HIV Association, the USPH in the United States, and the Brazilian Ministry of Health guidelines have recommended that, concerning antiretroviral treatment of HIV infected pregnant women, maternal health must be prioritised and if she requires treatment for her own health other drugs should be added to the 076 regimen. [9][10][11] Information about the safety and tolerance of these drugs has been largely reported from animal studies, case reports, and a few clinical trials. There are few studies on the safety and pharmacokinetics of these agents in pregnant women.…”