Updated recommendations for use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and interventions to reduce perinatal HIV-1 transmission in the United States
The August 30, 2002 updated Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission in the United States includes revisions to the following sections:
- Combination antiretroviral therapy and pregnancy outcome (page 5). This addresses the association between the receipt of combination therapy during pregnancy and preterm delivery. Data from a large meta analysis of seven clinical trials finds no association with prematurity, low birth weight or still birth with use of combination therapy compared to monotherapy or no antiretroviral therapy during pregnancy.
- International antiretroviral prophylaxis clinical trials (page 9), regarding the use of nevirapine, it includes data from HIVNet 012 in which transmission rate in women receiving short course maternal/neonatal ZDV was significantly higher than those in the trial arm receiving single dose NVP regimen. The guidelines do not discuss the issue of resistance using this strategy.
- Maternal risks by mode of delivery (page 23), regarding Caesarean delivery includes data showing increased rates of complications with this mode of delivery in HIV positive women compared to HIV negative women, with the difference most notable amongst women with more advanced disease. Unlike the British pregnancy guidelines C-section is not a universal recommendation for HIV-positive women.