 | 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 |
Antiretroviral therapy
The use of antiretroviral drugs in pregnancy should be considered for two indications: the health of the mother and prevention of transmission364,290,291. Pregnancy should not be a contra-indication for antiretroviral therapy in the mother, if indicated. The use of ZDV in the prevention of transmission to the fetus has been discussed above375,376,377. Current recommendations for adult antiretroviral therapy are that monotherapy with ZDV is sub-optimal treatment and that two antiretrovirals with the possible addition of a protease inhibitor is preferable288,289,378,379. Although there is a theoretical risk to the fetus from combination therapy, there is limited experience with the use of other antiretrovirals such as lamivudine, stavudine, and protease inhibitors in pregnancy. Some have recommended stopping these therapies during the first trimester and restarting the combinations, but this also carries a risk of developing resistance. Detailed recommendations have been released in the USA on combination therapy in pregnancy291. As many of the newer compounds do not have long-term safety data following use in pregnancy, this should be discussed with the patients. The use of any antiretroviral drugs should be accompanied by an explanation of the available knowledge to the women and advice that there should be long-term follow-up of the child272.
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