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Published on: March 30, 2014
HIV and pregnancy: screening and management update
1Infectious Diseases Unit, The Alfred Hospital, Melbourne, Victoria, Australia. scott.roberts@utsouthwestern.edu
Current Opinion in Obstetrics & Gynecology
|March 12, 2009
Summary
Recent studies highlight the importance of timely antiretroviral therapy for preventing mother-to-child HIV transmission during pregnancy. Research also indicates that caesarean sections increase morbidity without reducing transmission rates in women with undetectable viral loads.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Pediatrics
Background:
- Over 420,000 children were diagnosed with HIV in 2007, underscoring the need for effective prevention strategies.
- Antenatal screening and management of HIV in pregnancy remain critical public health concerns.
Purpose of the Study:
- To review recent publications on screening and management of HIV in pregnant individuals.
- To synthesize current evidence on preventing mother-to-child HIV transmission (PMTCT).
Main Methods:
- Review of recent publications, predominantly cohort studies.
- Analysis of data on HIV screening, antiretroviral therapy (ART), mode of delivery, and infant prophylaxis.
Main Results:
- Renewed interest in mandatory antenatal HIV testing.
- Late ART initiation during pregnancy is linked to increased HIV transmission risk.
- Intrapartum zidovudine importance diminishes with undetectable viral load at delivery.
- No difference in HIV transmission rates based on delivery mode for undetectable viral loads, but caesarean sections increase morbidity.
- Continuation of infant antiretroviral prophylaxis for breastfed infants shows promise but may increase toxicity and resistance.
Conclusions:
- Urgent need for research on optimal antenatal screening policies.
- Further investigation into optimal ART within resource constraints is required.
- Understanding preferred delivery modes considering morbidity and transmission is crucial.
- Development of new methods to protect breastfed infants from HIV infection is necessary.
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