British HIV Association and Children's HIV Association guidelines for the management of HIV infection in pregnant women 2008 (original) (raw)
Related papers
MANAGEMENT OF HIV IN PREGNANCY
1. Background HIV infection is associated with high morbidity and mortality. Effective treatment with a combination of three or more anti-retroviral drugs,known as highly active anti-retroviral therapy (HAART),has the capacity to prolong greatly the quality and length of life. British HIV Association guidelines regarding the treatment of HIV infection and HAART regimens used are available from the website: www.aidsmap.com. In the UK, it is estimated that 49 500 adults are infected with HIV, of whom one-third are unaware of their diagnosis. 1 Among adults newly diagnosed with HIV in the UK, 58% are thought to have acquired their infection through heterosexual exposure, of whom the majority are of black African ethnicity and who were probably infected in sub-Saharan Africa. 1 The incidence of heterosexually acquired HIV infection in the UK is rising steadily. Life expectancy is increased as a result of HAART.These factors have led to an increase in the prevalence of pregnant women who are HIV positive in the UK. 1 The Unlinked Anonymous Prevalence Monitoring Programme was introduced in 1990 to assess the prevalence of HIV infection, both diagnosed and undiagnosed, in accessible groups of the adult population. Data from this programme showed that, in 2002, there were an estimated 686 births to HIV-positive women in the UK, with over 60% of these in London. The prevalence of HIV infection in women giving birth in London was 0.38%, compared with 0.06% in both the rest of England and in Scotland. 1 The risk of mother-to-child transmission of HIV varies between 15% and 20% in non-breastfeeding women in Europe and between 25% and 40% in breastfeeding African populations. 2 Mother-to-child transmission of HIV is largely preventable where universal antenatal HIV screening is undertaken, exclusive artificial formula feeding is feasible and where there is the provision for anti-retroviral therapy and delivery by caesarean section.The principal risks of transmission are related to maternal plasma viral load, obstetric factors and infant feeding. It is well established that advanced maternal HIV disease, low antenatal CD4 T-lymphocyte counts and high maternal plasma viral loads are associated with an increased risk of mother-to-child transmission. 3 The latter is now recognised as being the strongest predictor of transmission.Two large studies demonstrated that perinatal transmission was significantly associated with maternal plasma viral load. 4,5 These studies also showed that no transmission occurred where maternal plasma viral load was less than 1000 copies/ml (0/57) 4 and less than 500 copies/ml (0/84). 5 However, a meta-analysis of seven prospective studies demonstrated 44 cases of perinatal HIV transmission among 1202 women with plasma viral loads of less than 1000 copies/ml at or near the time of delivery. 6 These data suggest that, at present, there is insufficient evidence for a plasma viral load threshold below which transmission never occurs. Current plasma viral load assays have lower limits of detection than those used in the above studies (as low as 50 copies/ml).
CMAJ - Canadian Medical Association Journal, 2003
, an estimated 19.2 million women worldwide were living with HIV infection. 1 It is clear that HIV-positive women are living longer and are choosing to become pregnant, and a substantial proportion of infected women give birth each year. 2,3 The perinatal transmission of HIV both in Canada 4-6 and around the world 1-3,7 is a source of concern. In fact, the vast majority of all HIV infections in children are acquired perinatally. 1-3,7 Thus, care of the mother and her offspring in the setting of HIV infection has become an important health care issue. Canadian consensus guidelines for the treatment of HIV infection in adults have been published previously, 8-10 but they contained only minimal information about the complexities of caring for HIV-positive pregnant women. In October 1998 a representative group of HIV and infectious disease specialists, obstetricians with interest and expertise in the care of HIV-positive pregnant women, family physicians, pediatric HIV specialists and community members convened to review recently published guidelines and their supporting scientific literature and to make recommendations. Information that became available after the 1998 workshop, either in published form or through presentation at conferences, was also considered before the guidelines were finalized. The guidelines therefore represent the current Canadian consensus on the care of HIV-positive pregnant women and their infants. These consensus recommendations are summarized as a commentary on page 1671 of this issue. 11 The full-length guidelines and the evidence supporting them can be accessed online at www.cmaj.ca. In this article we present 7 scenarios demonstrating how the recommendations are intended to be applied in practice. Scenario 1 An HIV-infected pregnant woman who is not receiving antiretroviral therapy when pregnancy is confirmed The woman's clinical, virologic and immunologic status should be assessed. Antiretroviral therapy should be offered, the regimen being carefully chosen on the basis of the principles outlined in the consensus guidelines. 11 If the
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2014
This guideline reviews the evidence relating to the care of pregnant women living with HIV and the prevention of perinatal HIV transmission. Prenatal care of pregnancies complicated by HIV infection should include monitoring by a multidisciplinary team with experts in this area. OUTCOMES evaluated include the impact of HIV on pregnancy outcome and the efficacy and safety of antiretroviral therapy and other measures to decrease the risk of vertical transmission. Published literature was retrieved through searches of PubMed and The Cochrane Library in 2012 and 2013 using appropriate controlled vocabulary (HIV, anti-retroviral agents, pregnancy, delivery) and key words (HIV, pregnancy, antiretroviral agents, vertical transmission, perinatal transmission). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English or French. There were no date restrictions. Searches were updated on a regular basis a...
HIV testing and treatment in the antenatal care setting
Irish medical journal, 2010
Routine linked HIV antenatal screening, with "opt-out", was introduced at the Rotunda in January 1998. This paper reviews the screening and subsequent pregnancy management and outcome in HIV positive women from 1998 to 2006. During this time 225 women (280 pregnancies) were HIV positive and 194 women subsequently delivered at the Rotunda, representing 233 liveborn infants. Overall anti-HIV prevalence was 0.42%, increasing from 0.06% in 1998 to 0.57% in 2006. Of 233 livebirths, 111 (48%) were delivered by spontaneous vaginal delivery (SVD). HIV treatment was started pre-pregnancy in 14 (6%) pregnancies and antenatally in 208 (90%). The vertical transmission rate in mothers receiving >4 weeks of treatment was 0%. We conclude that routine antenatal HIV screening is effective and significantly benefits the health of mother and child.
Infectious Diseases in Obstetrics and Gynecology
All HIV-infected women contemplating pregnancy should initiate combination antiretroviral therapy (cART), with a goal to achieve a maternal serum HIV RNA viral load beneath the laboratory level of detection prior to conceiving, as well as throughout their pregnancy. Successfully identifying HIV infection during pregnancy through screening tests is essential in order to preventin uteroand intrapartum transmission of HIV. Perinatal HIV transmission can be less than 1% when effective cART, associated with virologic suppression of HIV, is given during the ante-, intra-, and postpartum periods. Perinatal HIV guidelines, developed by organizations such as the World Health Organization, American College of Obstetricians and Gynecologists, and the US Department of Health and Human Services, are constantly evolving, and hence the aim of our review is to provide a useful concise review for medical providers caring for HIV-infected pregnant women, summarizing the latest and current recommendat...
HIV infection in pregnancy: Analysis of twenty cases
had a vaginal acute labour. All infants were administered zidovudine for four weeks after birth and were not breastfed by their mothers. Among the 21 infants, 4 were preterm (<37 weeks gestation) and 4 had a low birth-weight (<2,500gr) (19%). All infants were negative for HIV after a 6 months follow-up. Conclusion: Our results confirm that the recommended interventions are effective in controlling the HIV transmission to newborns and that early identification and treatment of all HIV-positive pregnant women can protect the next generation.