Perinatal HIV/AIDS Treatment Guidelines Updated
The Public Health Service yesterday released updated guidelines for use of antiretroviral drugs in HIV-positive pregnant women to reduce perinatal HIV transmission in the United States. Some highlights of the changes include:
- An expanded section on side effects of nucleoside reverse transcriptase inhibitors used during pregnancy. Recent data suggest that the combination of d4T and ddI may be dangerous for pregnant or postpartum women, as three deaths have occurred due to lactic acidosis.
- A new section titled "Preconceptional Counseling and Care for HIV-Infected Women of Childbearing Age," which outlines issues that are important for the health care provider to discuss with this population, such as contraception and treatment initiation to lower viral load.
- HIV-infected pregnant women who have not received prior antiretroviral therapy: A three-part AZT regimen should be recommended for all HIV-positive pregnant women and initiated after the first trimester. For women whose immunologic or virologic status requires treatment and all women with HIV RNA over 1,000 copies/mL, the combination of AZT and additional antiretroviral drugs is recommended.
- HIV-infected women receiving antiretroviral therapy during pregnancy: AZT should be a component of the antenatal antiretroviral treatment regimen "whenever possible." In addition, pregnant women should undergo resistance testing during acute HIV infection and following virologic failure or suboptimal viral suppression after initiation of antiretroviral therapy.
- Infants born to mothers who have received no antiretroviral therapy during pregnancy or intrapartum: The infant should receive early diagnostic testing so that if found to be HIV-positive, the infant can undergo treatment as soon as possible. Infants born to HIV-positive women should undergo AZT treatment within 6 to 12 hours after birth