 | HIV in Pregnancy: A Review (UNAIDS, 1999, 67 p.) |
 |  | (introduction...) |
| | EXECUTIVE SUMMARY |
| | INTRODUCTION |
|  | SECTION A : HIV IN PREGNANCY |
| | (introduction...) |
| | Epidemiology of HIV |
| | Susceptibility of women to HIV infection |
| | (introduction...) |
| | Biological factors |
| | Socio-cultural factors |
| | Effect of pregnancy on the natural history of HIV infection |
| | Effect of HIV infection on pregnancy |
| | Mother-to-child transmission |
| | (introduction...) |
| | Factors affecting mother-to-child transmission of HIV-1 |
| | Interventions to prevent mother-to-child transmission of HIV |
| | Appropriate interventions to reduce mother-to-child transmission |
| | (introduction...) |
| | Antiretroviral therapy |
| | Immune therapy |
| | Nutritional interventions |
| | Mode of delivery |
| | Vaginal cleansing |
| | Modification of infant feeding practice |
| | Voluntary HIV counselling and testing in pregnancy |
| | (introduction...) |
| | Testing of antenatal women |
| | Counselling before and after HIV testing in pregnancy |
| | Counselling about pregnancy-related issues |
| | SECTION B : MANAGEMENT OF HIV-POSITIVE PREGNANT WOMEN |
| | (introduction...) |
| | Antenatal care |
| | (introduction...) |
| | Obstetrical management |
| | Examination and investigations |
| | Medical treatment during pregnancy |
| | Antiretroviral therapy |
| | Care during labour and delivery |
| | Postpartum care |
| | Care of neonates |
| | SECTION C : INFECTION CONTROL MEASURES |
| | (introduction...) |
| | Universal precautions |
| | Risks of needlestick injuries |
| | (introduction...) |
| | Management of needlestick injuries and other accidental blood exposure |
| | REFERENCES |
Immune therapy
Both passive immunization with hyper-immune HIV immunoglobulin (HIVIG) and active immunization with HIV vaccines have been proposed as alternative mechanisms to prevent mother-to-child transmission111,113,292.
Passive immunization with intravenous HIV immunoglobulin has been investigated. A trial [ACTG185] of the use of HIVIG, in a cohort of women, who all received ZDV, was stopped after an interim analysis showed low transmission rates in both the study and control group. The transmission risk for the HIVIG Group was 4.1% (95% confidence interval 1.5%-6.7%) and the transmission risk for IVIG was 6.0% (95% confidence interval 2.8%-9.1%)293. Very large numbers would have been required to show any significant reduction in these rates attributable to the HIVIG use. Another study is ongoing in Uganda in ZDV na patients. Concerns remain about the costs and the donor sources for these products, standardized preparations and optimal delivery time.
Active immunization could possibly induce immunity in the mother and in the fetus by passive transfer of antibodies111,294. Effective vaccines have not yet been identified, although several Phase I/II trials are in progress113.
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