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perinatal transmission of HIV

Etiology: - HIV1 transmission may occur - in utero, at delivery, or during breast feeding Laboratory: - HIV testing of all women early in pregnancy is recommended [2] - secondary testing of high risk women during the 3rd trimester of pregnancy may be cost-effective [2] Management: - treatment of HIV+ women in the 2nd & 3rd trimester of pregnancy reduces risk of vertical transmission by 67% - zidovudine (AZT) should be administered to women near delivery if viral load exceeds >1000 copies/mL or is unknown [5] - zidovudine continuous infusion during labor - HIV-exposed neonates should receive AZT for 4-6 weeks, with nevirapine added in the first few days of life if maternal infection is uncontrolled [5] - AZT 2 mg/kg every 6 hours for 6 weeks - single dose intrapartum nevirapine reduces risk of perinatal HUV transmission by 40% [3] - addition of single dose tenofovir & emtricitabine to nevirapine reduces risk of drug-resistant viral mutations [4] - HIV+ women should NOT breast feed their infants; use formula - delivery by cesarean section does NOT prevent vertical transmission of HIV

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perinatal

General

complications in patients with HIV1 infection

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  2. Journal Watch 24(1):10, 2004 Sansom SL et al, Obstet Gynecol 102:782, 2003 PMID: 14551009
  3. Jackson JB et al, Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: 18 month follow-up to the HIVNET 012 randomised trial. Lancet 2003, 362:859 PMID: 13678973
  4. Chi BH et al, Single dose tenofovir and emtricitabine for reduction of viral resistance to non-nucleoside reverse transcriptase inhibitor drugs in women given intrapartum nevirapine for perinatal HIV prevention: An open-label randomised trial. Lancet 2007, 370:1698 PMID: 17997151 http:///dx.doi.org/10.1016/S0140-6736(07)61605-5
  5. Zuger A Use of Antiretroviral Drugs in Pregnancy. Physician's First Watch, April 22, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org - Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and interventions to reduce perinatal HIV transmission in the United States. 2014. AIDSinfo. Clinical Guidelines Portal. March 28, 2014. http://aidsinfo.nih.gov/Guidelines/HTML/3/perinatal-guidelines/0 (corresponding NGC guideline withdrawn March 2016)