Treatment for HIVpositive pregnant women
Apr 30, 2001
What is treatment for HIV positive pregnant woman?
Response from Dr. Pavia
There are at least three issues for an HIV infected pregnant woman. First, what is the best treatment for her? Second, what is the best treatment for preventing infection of the baby she is carrying. Third, does she want to consider having a planned Caesarian section, which in some settings offers additional protection.
The best resource is the PHS guidelines for prevention of perinatal transmission, available at www.hivatis.org.
Here are a few key points. According to the latest guidelines, any woman with a CD4 count of less than 350 or a viral load of 50,000 should plan on beginning treatment, once issues of adherence are addressed, regardless of whether or not she is pregnant. We know that treatment with combination therapy, particularly triple combination therapy, is very effective at reducing the risk of infection in the baby. With triple therapy, if the mother's viral load falls to below the limits of detection, the chance of the baby being infected falls to less than 1 in 100. Without any treatment, about 1 in 4 babies will be infected. For this reason, I think a pregnant HIV infected woman should also consider triple therapy if she would not ordinarily need to start it based on a higher CD4 count.
Rather than go through all of the information, let me just suggest that there are huge advances in the treatment of HIV infected pregnant women. It is vital, in my opinion, that the woman seek the care of someone with expertise and comfort in managing pregnancy in HIV. In some areas, there are one or two OB-GYNS with that expertise. However,most of the time you will want an HIV doc to help the OB with the mangagement.
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