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| {{AIDS}}
| | #REDIRECT [[HIV and pregnancy#Treatment]] |
| {{CMG}} '''Associate Editors-in-Chief:''' [[User:Ujjwal Rastogi|Ujjwal Rastogi, MBBS]] [mailto:urastogi@perfuse.org]
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| ==Overview==
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| The risk of HIV transmission from mother to infant had declined to low levels with the use of ART in USA and Europe. The risk for [[perinatal]] HIV transmission can be reduced to <2% through the use of antiretroviral regimens and [[obstetrical]] interventions (i.e., [[zidovudine]] or [[nevirapine]] and elective [[cesarean]] section at 38 weeks of pregnancy) and by avoiding [[breastfeeding]].<ref name="pmid16088819">{{cite journal |author=Bulterys M, Weidle PJ, Abrams EJ, Fowler MG |title=Combination antiretroviral therapy in african nursing mothers and drug exposure in their infants: new pharmacokinetic and virologic findings |journal=J. Infect. Dis. |volume=192 |issue=5 |pages=709–12 |year=2005 |month=September |pmid=16088819 |doi=10.1086/432490 |url=http://www.jid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=16088819 |accessdate=2012-02-22}}</ref>
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| == Therapeutic Goals==
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| *Reduction of perinatal transmission of infection.
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| *Treatment of maternal HIV disease.
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| ==ART Regimen==
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| Potential benefits and risks of therapy should be discussed with the patients by the health care provider. Following factors are taken into consideration for ART Selection:
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| * Comorbidities.
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| * Patient adherence and convenience of therapy.
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| * Potential for adverse drug effects on the mother and drug interactions.
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| * Pharmacokinetic changes in pregnancy
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| * Results of genotypic resistance testing.
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| *Potential teratogenic effects on the fetus and other adverse effects on the fetus or newborn.
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| ===ART for maternal health===
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| Treatment of HIV infection is no different for the pregnant female than the nonpregnant patient. For effective viral suppression and immune recovery, three-drug combination therapy is needed. | |
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| ===ART prophylaxis for prevention of perinatal HIV transmission===
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| Due to the use of appropriate ART prophylaxis which cause effective viral suppression, the risk of an infant becoming infected via perinatal transmission is currently estimated to be approximately 2 percent in USA and Europe.
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| Perinatal HIV infection can occur during the following conditions:
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| *During [[pregnancy]].
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| *[[Labor]] and [[delivery]].
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| *During the [[breastfeeding]] period.
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| ==Recommendations for counselling of HIV-Infected pregnant women==
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| Pregnant women who are HIV-infected should be counseled concerning their options (either on-site or by referral), given appropriate antenatal treatment, and advised not to breastfeed their infants.
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| Centers for Disease Control and Prevention gives the following recommendations:
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| *HIV-infected pregnant women should receive HIV prevention counseling as recommended. This counseling should include discussion of the risk for perinatal HIV transmission, ways to reduce this risk, and the prognosis for infants who become infected. HIV-infected pregnant women should also be told the clinical implications of a positive HIV antibody test result and the need for and benefit of HIV-related medical and other early intervention services, including how to access these services.
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| *HIV-infected pregnant women should be counseled regarding antiretroviral therapy during pregnancy to improve their health and prevent perinatal transmission. Medical care and management of HIV-infected persons, especially pregnant women, can be complicated because of the need for combination therapy with multiple drugs, management of common side effects, careful monitoring of viral load and drug resistance, prophylaxis for and treatment of opportunistic infections, and monitoring of immune status. Health-care providers who are not experienced in the care of pregnant HIV-infected women are encouraged to obtain referral for specialty care from providers who are knowledgeable in this area.
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| *HIV-infected pregnant women should receive information regarding all reproductive options. Reproductive counseling should be nondirective. Health-care providers should be aware of the complex concerns that HIV-infected women must consider when making decisions regarding their reproductive options and should be supportive of any decision.
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| ==Recommendations for HIV-Infected pregnant women==
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| [http://aidsinfo.nih.gov/contentfiles/Peri_Recommendations.pdf]
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| Although pregnancy is not an adequate reason to defer therapy for HIV infection, unique considerations exist regarding use of antiretroviral drugs during pregnancy, including the potential need to alter dosing because of physiologic changes associated with pregnancy, the potential for adverse short- or long-term effects on the fetus and infant, and the effectiveness in reducing the risk for perinatal transmission.
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| * Obstetric providers should adhere to best obstetric practices, including offering scheduled cesarean section at 38 weeks to reduce risk for perinatal HIV transmission.<ref name="pmid8642957">{{cite journal |author=Biggar RJ, Miotti PG, Taha TE, Mtimavalye L, Broadhead R, Justesen A, Yellin F, Liomba G, Miley W, Waters D, Chiphangwi JD, Goedert JJ |title=Perinatal intervention trial in Africa: effect of a birth canal cleansing intervention to prevent HIV transmission |journal=Lancet |volume=347 |issue=9016 |pages=1647–50 |year=1996 |month=June |pmid=8642957 |doi= |url= |accessdate=2012-02-24}}</ref><ref name="pmid10390276">{{cite journal |author= |title=Human immunodeficiency virus screening. Joint statement of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists |journal=Pediatrics |volume=104 |issue=1 Pt 1 |pages=128 |year=1999 |month=July |pmid=10390276 |doi= |url=http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=10390276 |accessdate=2012-02-24}}</ref>
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| *All pregnant women who require therapy for their own health should receive a combination antepartum antiretroviral (ART) drug regimen containing at least three drugs for treatment, which will also reduce the risk of perinatal transmission.
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| * Combination antepartum drug regimens are also recommended for prevention of perinatal transmission in women who do not yet require therapy for their own health.
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| * ART prophylaxis is more effective when given for a longer than a shorter duration. Therefore, ART drugs should be started as soon as possible in women who require treatment for their own health (AI), and without delay after the first trimester in women who do not require immediate initiation of therapy for their own health, although earlier initiation can be considered in these women as well.
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| *In the absence of antepartum administration of ART drugs, ART drugs should be administered intrapartum in combination with infant ART prophylaxis to reduce the risk of perinatal transmission (AI); if antepartum and intrapartum ART drugs are not received, infant ART prophylaxis should be provided (see Infant Antiretroviral Prophylaxis) (AI).
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| *Adding single-dose intrapartum/newborn nevirapine to the standard antepartum combination ART regimens used for prophylaxis or treatment in pregnant women in the United States is not recommended. This is because the drug does not appear to provide additional efficacy in reducing transmission and it may be associated with development of nevirapine resistance (AI).
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| * To eliminate the risk for postnatal transmission, HIV-infected women in the United States should not breast-feed. Support services for use of appropriate breast milk substitutes should be provided when necessary. UNAIDS and World Health Organization recommendations for HIV and breast-feeding should be followed in international settings. Thus breastfeeding is not recommended for HIV-infected women in the United States—including those receiving combination antiretroviral therapy (ART)—because safe, affordable, and feasible alternatives are available (AII).
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| *To optimize medical management, positive and negative HIV test results should be available to a woman's health-care provider and included on her confidential medical records and those of her infant. After informing the mother, maternal health-care providers should notify the pediatric-care providers of the impending birth of an HIV-exposed infant and any anticipated complications. If HIV is first diagnosed in the infant, health-care providers should discuss the implications for the mother's health and help her obtain care. Women should also be encouraged to have their other children tested for HIV. Children can be infected with HIV for many years before complications occur. Providers are encouraged to build supportive health-care relationships that promote discussion of pertinent health information. Confidential HIV-related information should be disclosed or shared only in accordance with prevailing legal requirements.
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| *After receiving their test results, HIV-infected pregnant women should receive counseling, including assessment of the potential for negative effects (e.g., discrimination, domestic violence, psychological difficulties). Counseling should also include information on how to minimize these consequences, assistance in identifying supportive persons in their own social networks, and referral to appropriate psychological, social, and legal services. HIV-infected women should be counseled regarding the risk for transmission to others and ways to decrease this risk. They also should be told that discrimination based on HIV status or AIDS in housing, employment, state programs, and public accommodations (including physicians' offices and hospitals) is illegal.
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| *Health-care providers should follow the Public Health Service Task Force recommendations for using antiretroviral drugs to treat pregnant HIV-1 infected women and reduce perinatal HIV-1 transmission in the United States, which address treating pregnant women who do not receive health care until near the time of delivery.
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| ==Reference==
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| {{reflist|2}}
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| {{Viral diseases}}
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| {{STD/STI}}
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| [[Category:HIV/AIDS]]
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| [[Category:Immune system disorders]]
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| [[Category:Infectious disease]]
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| [[category:viral diseases]]
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| [[Category:Sexually transmitted infections]]
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| [[Category:Syndromes]]
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| [[Category:Virology]]
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| [[Category:AIDS origin hypotheses]]
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| [[Category:Immunodeficiency]]
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| [[Category:Microbiology]]
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| {{Link FA|he}}
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| {{Link FA|vi}}
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| [[af:Vigs]]
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| [[als:AIDS]]
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| [[am:ኤድስ]]
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| [[an:SIDA]]
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| [[ar:متلازمة العوز المناعي المكتسب]]
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| [[ast:SIDA]]
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| [[az:QİÇS]]
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| [[bat-smg:AIDS]]
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| [[be-x-old:СНІД]]
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| [[bg:Синдром на придобитата имунна недостатъчност]]
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| [[bm:Sida]]
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| [[bn:এইডস]]
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| [[bs:Sida]]
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| [[ca:SIDA]]
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| [[cs:AIDS]]
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| [[da:Aids]]
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| [[de:Aids]]
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| [[dv:އެއިޑްސް ބަލި]]
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| [[el:AIDS]]
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| [[eo:Aidoso]]
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| [[es:SIDA]]
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| [[et:AIDS]]
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| [[eu:Hartutako Immuno Eskasiaren Sindromea]]
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| [[fa:ایدز]]
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| [[fi:AIDS]]
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| [[fr:Syndrome d'immunodéficience acquise]]
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| [[fur:AIDS]]
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| [[ga:SEIF]]
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| [[gd:AIDS]]
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| [[gl:SIDA]]
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| [[gu:એડ્સ]]
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| [[he:איידס]]
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| [[hi:एड्स]]
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| [[hr:Sindrom stečene imunodeficijencije]]
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| [[ht:Sida]]
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| [[hu:AIDS]]
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| [[hy:ՁԻԱՀ]]
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| [[id:AIDS]]
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| [[is:Alnæmi]]
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| [[it:AIDS]]
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| [[ja:後天性免疫不全症候群]]
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| [[ka:შიდსი]]
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| [[ki:AIDS]]
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| [[km:ជំងឺអេដស៍]]
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| [[kn:ಏಡ್ಸ್ ರೋಗ]]
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| [[ko:에이즈]]
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| [[ku:AIDS]]
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| [[la:SCDI]]
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| [[lb:Aids]]
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| [[ln:Sida]]
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| [[lo:ເອດສ໌]]
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| [[lt:AIDS]]
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| [[lv:AIDS]]
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| [[mk:СИДА]]
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| [[ml:എയ്ഡ്സ്]]
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| [[mn:Дархлалын олдмол хомсдол]]
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| [[mr:एड्स]]
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| [[ms:AIDS]]
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| [[mt:AIDS]]
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| [[new:एड्स]]
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| [[nl:Aids]]
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| [[nn:Hiv/aids]]
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| [[no:Aids]]
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| [[oc:SIDA]]
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| [[pl:Zespół nabytego niedoboru odporności]]
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| [[ps:اېډز]]
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| [[pt:Síndrome da imunodeficiência adquirida]]
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| [[qu:Unquy hark'aypa chaskisqa waqlliynin]]
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| [[ro:SIDA]]
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| [[ru:Синдром приобретённого иммунного дефицита]]
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| [[scn:AIDS]]
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| [[si:ඒඩ්ස්]]
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| [[ta:எய்ட்ஸ்]]
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| [[tr:AIDS]]
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| [[tt:AİDS]]
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| [[uk:СНІД]]
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| [[ur:محصولی کسرمناعی متلازمہ]]
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| [[uz:Orttirilgan Imunitet Tanqisligi Sindromi]]
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| [[vec:AIDS]]
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| [[yi:עידס]]
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