The management of HIV-infected pregnant women

The management of HIV-infected pregnant women

Author Senise, Jorge Autor UNIFESP Google Scholar
Bonafe, Simone Autor UNIFESP Google Scholar
Castelo, Adauto Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract Purpose of reviewThe purpose of this article is to update the current practice in the management of HIV-infected pregnant women and present evidence-based recommendations for the reduction of mother-to-child transmission.Recent findingsEarly and sustained control of HIV viral replication is associated with decreasing residual risk of transmission and favors initiating antiretroviral drugs sufficiently early in naive women to suppress viral replication by the third trimester; however, this potential benefit must be balanced against the unknown long-term outcome of first-trimester drug exposure. Efavirenz should whenever possible be avoided in the first trimester of gestation, but its use seems well tolerated for 39 days after last menstrual period when the neural tube closes. Raltegravir may be considered in special circumstances in pregnancy.SummaryThe HIV viral load and the risk factors for prematurity must be considered when deciding when to start antiretroviral treatment in each individual pregnant woman. A ritonavir-boosted protease inhibitor combined with two nucleoside reverse transcriptase inhibitors is currently the most widely used regimen. Among protease inhibitors, lopinavir combined with ritonavir is the most frequently used; however, atazanavir combined with ritonavir is a good alternative. Elective cesarean section is the best delivery mode for pregnant women with viral loads more than 50 copies/ml.
Keywords antiretroviral therapy
HIV
pregnancy
vertical transmission
Language English
Date 2012-12-01
Published in Current Opinion in Obstetrics & Gynecology. Philadelphia: Lippincott Williams & Wilkins, v. 24, n. 6, p. 395-401, 2012.
ISSN 1040-872X (Sherpa/Romeo, impact factor)
Publisher Lippincott Williams & Wilkins
Extent 395-401
Origin http://dx.doi.org/10.1097/GCO.0b013e328359f11e
Access rights Closed access
Type Review
Web of Science ID WOS:000311419500006
URI http://repositorio.unifesp.br/handle/11600/35587

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