HIV in Pregnancy: A Review (UNAIDS, 1999, 67 p.): SECTION A : HIV IN PREGNANCY: Voluntary HIV counselling and testing in pregnancy: Counselling about pregnancy-related issues

HIV in Pregnancy: A Review (UNAIDS, 1999, 67 p.)

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EXECUTIVE SUMMARY

INTRODUCTION

SECTION A : HIV IN PREGNANCY

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Epidemiology of HIV

Susceptibility of women to HIV infection

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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

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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

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Antiretroviral therapy

Immune therapy

Nutritional interventions

Mode of delivery

Vaginal cleansing

Modification of infant feeding practice

Voluntary HIV counselling and testing in pregnancy

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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

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Antenatal care

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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

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Universal precautions

Risks of needlestick injuries

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Management of needlestick injuries and other accidental blood exposure

REFERENCES

Counselling about pregnancy-related issues

There are several issues to be addressed when counselling HIV positive pregnant women, in addition to the general issues related to HIV infection. These include information about the interactions of HIV and pregnancy, options of termination of pregnancy, discussion about disclosure to the male partner, the risk of mother-to-child transmission and possible interventions to prevent this, other treatment options, infant feeding and HIV and future fertility. Some of these pregnancy-related issues are detailed in Table 7.

Table 7 : Issues in counselling HIV-positive pregnant women

The effect of pregnancy on HIV infection
The effect of HIV infection on pregnancy outcome: risks of adverse pregnancy events
The risk of transmission to the fetus during pregnancy, delivery and breastfeeding
Termination of pregnancy options
Treatment options during pregnancy
Interventions available to attempt to prevent mother-to-child transmission
Infant feeding options: the advantages and disadvantages of breastfeeding
Disclosure of results to male partners and/or to other significant family or community members: advantages and risks
The need for follow-up of both mother and child
Future fertility and contraceptive options

HIV-infected women should be given appropriate information to make informed decisions about the continuation of their pregnancy and future fertility³⁴⁸. Termination of pregnancy should be offered to HIV positive women; where this is legal. It should be clear to health care workers that offering termination should never be coercive and that all women, irrespective of their HIV status, have the right to determine the course of their reproductive life. Although there are some reports of increased rates of termination in HIV positive women, the majority of women will elect to continue with the pregnancy^{249,349,350,351}. Knowledge of HIV infection had little effect on reproductive trends and the decision on future children in a number of studies^{248,352,353,354} although this has been seen more in developing countries than developed countries. However, a family planning intervention in Rwanda, providing access to and information about contraceptives, showed a reduction in subsequent pregnancies which was greater than in HIV-negative women³⁵⁵, and other studies have shown a reduction in the number of pregnancies in HIV positive women^{349,356,357,358}.