[Decision guides for antiretroviral treatment in pregnancy]

HIV-infected adults can now be offered highly active antiretroviral combination therapies. Major advances in understanding the pathogenesis of HIV-infection have led to earlier onset of treatment during the course of HIV infection. Most of the new antiretroviral drugs are not approved for use in newborns and infants. Zidovudine monotherapy during pregnancy, during labor and for the newborn, has been shown to reduce vertical HIV transmission by almost 70%. Zidovudine monotherapy is at present considered obsolete for the treatment of HIV-infected adults. Thus, during pregnancy, both the interests of the HIV-infected mother and the fetus/newborn must be taken into account. Clinical data to solve this dilemma are not available. In general, standard antiretroviral treatment should not be withheld from pregnant HIV-infected women, but prescription has to be the result of careful discussion of the risks and benefits of such treatment during pregnancy. The final decision about treatment, whether primarily for the mother, to reduce vertical transmission or both, has to be taken by the pregnant women. This discussion and information must involve physicians with important experience in the treatment of HIV-infected patients.