Acquired Immunodeficiency Syndrome (AIDS) (cont.)

There are two goals of treatment for pregnant women with HIV infection: to treat maternal infection and to reduce the risk of HIV transmission from mother to child. Women can pass HIV to their babies during pregnancy, during delivery, or after delivery by breastfeeding. Without treatment of the mother and without breastfeeding, the risk of transmission to the baby is about 25%. With treatment of the mother before and during birth and with treatment of the baby after birth, the risk decreases to less than 2%. Some antiretroviral medications cannot be used in pregnancy and others have not been studied in pregnancy. For example, the medication efavirenz (Sustiva) is usually avoided in early pregnancy or in women who are likely to become pregnant. Fortunately, there are treatment regimens that have been shown to be well-tolerated by most pregnant women, significantly improving the outcome for mother and child. The same principles of testing for drug resistance and combining antiretrovirals that are used for nonpregnant patients are used for pregnant patients. All pregnant women with HIV should be treated with HAART regardless of their CD4 cell count, although the choice of drugs may differ slightly from nonpregnant women.

Compliance with medications is important to provide the best outcome for mother and child. Even though a physician might highly recommend a medication regimen, the pregnant woman has a choice of whether or not to take the medicines. Studies have shown that compliance is improved when there is good communication between the woman and her doctor, with open discussions about the benefits and side effects of treatment. Compliance also is improved with better social support, including friends and relatives.

Medications are continued throughout pregnancy, labor, and delivery. Some medicines, such as zidovudine (also known as AZT), can be given intravenously during labor. Other medications are continued orally during labor to try to reduce the risk of transmission to the baby during delivery. If the mother's HIV viral load is more than 1,000 copies near the time of delivery, scheduled cesarean delivery is done at 38 weeks gestation because of a higher risk for transmitting the virus during vaginal delivery. Women with HIV who otherwise meet criteria for starting antiretroviral therapy should continue taking HAART after delivery for their own health. In the U.S., breastfeeding is not recommended if the mother has HIV.

If a pregnant woman with HIV infection does not take HAART during pregnancy and goes into labor, medications are still given during labor. This reduces the risk of transmission of HIV. After delivery, the infant will be given medication(s) for at least six weeks to reduce the risk of transmission of HIV. If the mother did not take HAART during pregnancy or if the mother has a drug-resistant virus, infants will be treated with multiple medications. Infants are tested periodically in the first six months to ensure they have not acquired the virus.

Source: MedicineNet.com
http://www.medicinenet.com/acquired_immunodeficiency_syndrome_aids/article.htm