UK (BHIVA) pregnancy guidelines online for comment (2007)
Polly Clayden, HIV i-Base
The 2007 Pregnancy Guidelines are posted for consultation on the BHIVA site. Following the consultation and any revisions, the BHIVA council will ratify the final version and they will be presented at the BHIVA Autumn conference.
The guidelines explain, The success of antenatal testing for HIV means that more clinicians than ever are involved in the care of women with HIV who are pregnant. But the authors note Despite very few recent RCTs regarding the use of ARVs in pregnancy or obstetric interventions practice is changing. This is informed largely by observational data and theoretical considerations and these guidelines reflect this. The Cochrane Systematic Review of RCTs in this area shows how limited the guidelines would be were they to be restricted to such high level evidence.
Changes from the 2005 guidelines include:
- A greater range of clinical scenarios to include more consideration of adverse obstetric events, especially prematurity (see article below). This reflects the nature and volume of calls to the writing committee from fellow clinicians.
- Clearer recommendations regarding documentation of antenatal HIV testing, consideration to be given to repeat testing of women noted to be at continuing higher risk of HIV acquisition and advice to consider near patient HIV testing for untested in women in labour and further reduction in detail on teratogenicity as this is better covered by reference to the Antiretroviral Pregnancy Registry.
- There are few substantive changes to the recommendations on the use of individual ARVs. The use of AZT monotherapy plus PLCS remains an option for selected women.
- There is more detail in the obstetric management section, reflecting the greater diversity of clinical situations being encountered, in part as a result of more women choosing to take START and try for an elective vaginal delivery.
- The recommendations for infant feeding in the UK remain unchanged.
Full details can be found on the BHIVA web site