Medical treatment during pregnancy
The medical care of HIV positive women should be tailored to the
individual needs of the woman. In general, pregnancy is not a contraindication
for the most appropriate antiretroviral therapy for a woman or for most of the
medical management of HIV-related conditions, but the risk to the fetus should
always be considered, and treatment modified if necessary290.
The value of vitamin A supplementation in reducing transmission
has not been proven, but multivitamins may provide cost effective nutritional
support372,373,374. Mebendazole should be given at the first visit in
areas of high hookworm prevalence.
Malaria in pregnancy causes high maternal and infant morbidity
and mortality, and may be associated with increased risk of mother-to-child
transmission of HIV216.217. Current recommendations are that
intermittent treatment with an effective, preferably one-dose antimalarial drug
should be made available to all primigravidae and secundigravidae in highly
endemic areas. This should be started from the second trimester and given at
intervals of not more than one month apart.
Prophylaxis for opportunistic infections should be given in
pregnancy, as indicated by the clinical stage of the HIV infection, and
according to local policy. Prophylaxis and treatment for tuberculosis should be
given where indicated, although streptomycin and pyrazinamide are not
recommended during pregnancy. Pneumocystis carinii pneumonia (PCP)
prophylaxis should continue through pregnancy: sulfamethoxazole/trimethoprim
(Bactrim/Septran) or pentamidine can be used. The risk to the fetus of maternal
sulphonamide administration in the third trimester is outweighed by the risk to
maternal health of PCP and kernicterus has not been reported where the drug was
not also used in the neonatal period5. Consideration should be given
to pneumococcal and Hepatitis B vaccination.
Treatment for opportunistic infections during pregnancy depends
on the clinical stage of the patient. Treatment regimens should follow local
policy guidelines. Where a variety of treatment options are available, those
with the lowest risk to the fetus should be used. Dermatological conditions are
common in HIV positive women and men, and treatment may be required for
prolonged periods. Acyclovir can be used safely after the first trimester.
Topical imidazole antifungals or topical gentian violet can be used throughout
pregnancy and oral fluconazole can be used after the first trimester, if