Data di Pubblicazione:
2002
Citazione:
Pregnancy and HIV infection: A european consensus on management / O. Coll, S. Fiore, M. Floridia, C. Giaquinto, I. Grosch-Wörner, M. Guiliano, S. Lindgren, H. Lyall, L. Mandelbrot, M. Newell, C. Peckham, C. Rudin, A. E. Semprini, G. Taylor, C. Thorne, P. Tovo. - In: AIDS. - ISSN 0269-9370. - 16 Suppl 2:2(2002 Jun), pp. S1-18.
Abstract:
The number of adults becoming infected in Europe continues to increase, with heterosexual contact accounting for a growing proportion of cases in Western Europe. There is particular concern for the increasing numbers of infected people reported from Eastern Europe, where the current infrastructure may be unable to cope with a rapidly evolving epidemic. HIV infection and transmission thus remains an important issue in Europe. The risk of mother-to-child transmission of HIV infection can be substantially reduced from 15-20% without interventions to less than 2% with the use of antiretroviral therapy during pregnancy, during labour and in the neonatal period, with an elective caesarean section delivery and refraining from breastfeeding. Potent and effective antiretroviral therapy [highly active antiretroviral therapy (HAART)] to delay progression of disease in HIV-infected adults has become the standard of care, and is usually applied before serious disease has developed. There is anecdotal evidence to suggest that HIV-infected women may now positively choose to become pregnant and that those who do become pregnant are less likely to have this pregnancy terminated, because their own disease is well managed and interventions to reduce the risk of vertical transmission are available. Given the current situation in Europe, where the vast majority of paediatric HIV infections acquired from mother to child are preventable, the standard of care should be that all pregnant women, and even those planning a pregnancy, are not only offered, but recommended to have, an HIV test. Furthermore, a test should also be offered to their sexual partners. If a woman is treated with antiretroviral drugs before becoming pregnant, a second trimester fetal anomaly scan may be reassuring. There are no data to suggest that these drugs are associated with an increased risk of teratogenicity, with the exception of efavirenz, zalcitabine and hydroxyurea, which are contraindicated during pregnancy. An elective caesarean section delivery substantially reduces the risk of mother-to-child HIV transmission, with an independent effect on vertical transmission even in women with a low viral load and in those on effective antiretroviral therapy. HIV-infected women should therefore be given the option of delivering their child through a caesarean section performed before labour and before rupture of membranes. Advantages and disadvantages of this option should be discussed. All HIV-infected women should be offered therapy during pregnancy, taking into account that it involves two different people; the infected pregnant woman and her infant, who is usually not infected. The choice of therapy and timing of initiation will depend on the clinical status of the woman and has to balance delaying disease progression and prevention of vertical transmission. The decision should be based on the woman's treatment history, clinical status and the available prognostic markers, CD4 lymphocyte counts and plasma HIV-RNA levels. These markers are related to the likelihood of disease progression in the mother and also to the risk of vertical HIV transmission. For the prevention of mother-to-child transmission, zidovudine (ZDV) monotherapy remains the standard prophylaxis. Data from the 076 trial and observational studies indicate that selection of ZDV-resistant virus rarely occurs with the 3- to 6-month regimen used in pregnancy. Some clinicians suggest the use of HAART for all women to reduce the risk of vertical transmission, but there is no evidence to substantiate this suggestion and the issue remains controversial. Although the objective of achieving the lowest possible viral load in pregnancy may be appealing, even with maternal plasma HIV-RNA levels above 1000 copies/ml, more than
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
Infectious Disease Transmission, Vertical; Breast Feeding; Humans; Pregnancy Complications, Infectious; Drug Resistance; Zidovudine; Child; Prenatal Care; Child Welfare; Preconception Care; Patient Compliance; Infant Nutritional Physiological Phenomena; Antiretroviral Therapy, Highly Active; Anti-HIV Agents; Health Status; Infant, Newborn; Counseling; Pregnancy; Drug Resistance, Viral; Contraception; HIV Infections; Postnatal Care; Follow-Up Studies; Cesarean Section; Female
Elenco autori:
O. Coll, S. Fiore, M. Floridia, C. Giaquinto, I. Grosch-Wörner, M. Guiliano, S. Lindgren, H. Lyall, L. Mandelbrot, M. Newell, C. Peckham, C. Rudin, A. E. Semprini, G. Taylor, C. Thorne, P. Tovo
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