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Antiretroviral and intrapartum management of pregnant HIV-infected women and their infants in resource-rich settings

Authors
Brenna Hughes, MD, MSc
Susan Cu-Uvin, MD
Section Editor
Lynne M Mofenson, MD
Deputy Editor
Allyson Bloom, MD

INTRODUCTION

The management of the pregnant woman with HIV infection has evolved significantly over the past 25 years in light of advancements in drug development and a greater understanding of the prevention of perinatal HIV transmission. In the United States and Europe, the risk of HIV transmission from mother to infant had declined to historically low levels with the use of antiretroviral medications [1,2]. Contributions to this successful prevention effort include universal testing of pregnant women for HIV infection, the use of cesarean delivery (when appropriate), and avoidance of breastfeeding, when feasible. (See "Prenatal evaluation of the HIV-infected woman in resource-rich settings".)

This topic will address antiretroviral treatment (ART) in the HIV-infected pregnant woman, intrapartum management, and antiretroviral prophylaxis of her infant in resource-rich settings. In October 2016, the Department of Health and Human Services in the United States published updated guidelines on the evaluation and management of HIV-infected pregnant women [3]. Our recommendations below are largely consistent with these guidelines.

Other guidelines that are relevant to resource-rich settings include those from the British HIV Association and the European AIDS Clinical Society [4,5].

Information regarding antepartum evaluation and teratogenicity and the pharmacokinetics of individual agents during pregnancy is found elsewhere. (See "Prenatal evaluation of the HIV-infected woman in resource-rich settings" and "Safety and dosing of antiretroviral medications in pregnancy".)

Information regarding the management of the HIV-infected pregnant female in resource-limited settings and the prevention of HIV transmission during breastfeeding is found elsewhere. (See "Prevention of mother-to-child HIV transmission in resource-limited settings" and "Prevention of HIV transmission during breastfeeding in resource-limited settings".)

                                   

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Literature review current through: Nov 2016. | This topic last updated: Mon Nov 21 00:00:00 GMT+00:00 2016.
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