Guidelines for the Use of Antiretroviral Therapy in HIV-Infected Pregnant Women

When a woman is able to give birth, that is a gift. But when an HIV-positive woman is able to give birth, and the baby turns out to be negative, that is a miracle of medicine. It is imperative for us women to love and take care of ourselves enough, in order to be able to care for a baby before they are born and after. So, if you are pregnant or thinking about becoming pregnant and you are HIV positive, here are some guidelines recommended by the Department of Health and Human Services (DHHS).

The DHHS is the United States government's principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves.

HIV-infected pregnant women should be offered antiretroviral therapy during their pregnancy. The health care provider should discuss with the expectant mother the known benefits and/or risks to her, and her fetus. When the viral load (HIV-1 RNA) is less than 1,000 copies/ml (milliliters), infected pregnant women should be counseled regarding the potential benefits of standard combination therapy including the three-part ZDV (AZT) chemoprophylaxis regimen (which means prevention of disease by the use of chemicals or drugs). Although some women are at low risk for disease progression if combination therapy is delayed, antiretroviral therapy that successfully reduces HIV-1 RNA levels to below 1,000 copies/ml substantially lowers the risk of perinatal transmission and limits the need to consider elective cesarean delivery as an intervention to reduce transmission risk.

HIV-infected pregnant women generally are given a three-part regimen of AZT, given orally after the first trimester (the first three months of pregnancy):

• 100mg (milligrams) of AZT by mouth five times a day and continued throughout pregnancy.

  1. Intravenously during labor in a 1-hour loading dose of 2mg per kg (kilogram) of body weight, followed by continuous IV (intravenous) of 1mg per kg of body weight per hour until delivery.

  2. The newborn for the first six weeks of life, is administered the syrup form (AZT), 2mg per kg body weight every six hours.

  3. Or, if given by IV, 1.5mg per kg body weight every 6 hours.

When women follow this regimen, the transmission risk can be reduced to only .05%. This regimen is recommended for all HIV-positive pregnant women.

We still find it quite interesting that HIV-positive pregnant women are dosed according to their body weight. And contrarily, HIV-positive non-pregnant women are dosed according to studies done in HIV-positive men. It's so nice to know that some things never change.

As of May 4, 2001, the DHHS guidelines recommendations have been updated:

• Treat (offer drugs to) all HIV-positive pregnant women. The pregnancy guidelines suggest all pregnant women take HIV drugs to reduce the risk of passing HIV to the neonate (baby).

• HIV-positive pregnant women should avoid or be extremely cautious about certain drugs and/or drug combinations throughout their pregnancy. These include but are not limited to:

  The oral solution of amprenavir (Agenerase). Hydroxyurea must be completely avoided in pregnancy, and so should Sustiva. Also the combination of Zerit (d4T) and Videx (ddI) is not recommended. (Please be sure to discuss "drugs to avoid" with your doctor.)

• Pregnant women with viral loads over 1,000 should have C-sections done at 36 weeks instead of 38 weeks. Providers should get the woman's full informed consent before doing a C-section, because a C-section is major surgery and poses risks to the woman's health.

Also the Health Care Financing Administration, which is a federal agency within the DHHS, recommends while you are pregnant:

• Get prenatal care early in your pregnancy (which consists of HIV testing and counseling).

• Exercise regularly if your health care provider says it's okay.

• Practice safe sex by using condoms -- even during pregnancy.

• Do not drink alcoholic beverages (e.g., beer, wine, cocktails).

• Do not smoke.

• Do not use illegal drugs or other drugs not prescribed by your doctor.

• Tell your health care provider about any medicine and/or herbs you are already taking.

If you are thinking about becoming pregnant or you are already pregnant, getting proper care and communicating with your doctor will help to ensure that you will have a healthy baby who is not HIV positive.

Sources: The Department of Health and Human Services, the Health Care Financing Administration and WORLD (Women Organized to Respond to Life-Threatening Diseases).