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High Risk Pregnancy

Anemia in Pregnancy
Diabetes in Pregnancy
Hypertension in pregnancy
Cardiac disease in pregnancy
Liver disease in pregnancy
Malaria in Pregnancy
HIV infection in pregnancy
Recurrent Abortion
Pregnancy and Renal Disease
Hematological Problems in Pregnancy
Hemoglobinopathies in Pregnancy
Thrombophilia in Pregnancy

HIV infection in pregnancy

  • A woman with HIV can transmit the virus to her infant either during pregnancy, labor or after childbirth via breastfeeding. Several factors are associated with a higher risk of transmission, including the maternal viral load and CD4 cell count.
  • Without treatment, the chance of transmitting HIV from a mother to a baby is somewhere between 12 and 25% in the developed world, and between 20 and 45% in resource-limited settings. It is greatly influenced by whether the child is breastfed.
  • In 1994, a controlled clinical trial demonstrated that treatment with AZT zidovudine, during pregnancy, delivery and to the infant after birth can reduce the risk of mother-to-child transmission of HIV by two-thirds. Subsequent studies reported that other treatment courses with AZT and other antiretroviral drugs could also reduce the likelihood of infection of the infant.
  • One trial in Uganda demonstrated significant reductions in HIV transmission simply by giving a single dose of nevirapine to the mother at the start of labor and to her infant within 72 hours of childbirth. This simple and inexpensive approach allowed resource-limited countries to design and implement programmes for the prevention of mother-to-child transmission. However, there are concerns that this strategy could lead to the development of nevirapine resistance in mothers and infants who become infected. This could limit their future treatment options.
  • In the developed world, widespread use of antiretroviral therapy during pregnancy has been associated with a dramatically reduced incidence of mother-to-child transmission among women with HIV who do not breastfeed.
  • The long-term safety of exposure to antiretroviral drugs in the womb and early in life is not known, and is a risk that must be balanced against the benefit of reduced HIV transmission. There is little evidence that antireroviral drugs cause a significant risk of serious abnormalities.
  • Planned caesarean delivery reduces mother-to-baby transmission in women who do not take any treatment, and in women who receive AZT in pregnancy. However, it is not clear whether this mode of delivery is advisable for pregnant women whose viral load is suppressed by antiretroviral therapy.
  • The management of any HIV-positive pregnant woman requires a careful consideration of the balance between the mothers health needs, locally available treatment options, the need to reduce transmission and the adverse effects of antiretroviral therapy.
    Recommended treatment options vary by country and local resources.
  • After birth, breastfeeding poses an ongoing transmission risk, and additional effective measures are needed to reduce transmission through this route.
  • Most women in the developed world choose to feed their child with infant formula. However, in resource-poor settings, replacement feeding is not always a viable option because of the lack of safe water or a reliable supply of infant formula. Even when formula is available, the choice is not a simple one in areas where malnutrition and childhood illness are common, because infants who are not breastfed are more likely to die from other causes.
  • Two studies have shown that mixed breast and formula or solid feeding carries a higher risk of HIV transmission than exclusive breastfeeding. Exclusive breastfeeding and early weaning are recommended.
  • Ongoing studies are evaluating the potential role for antiretroviral treatment to prevent HIV transmission to breastfed infants.
  • Though PPTC appears to have become more complicated, it continues to be the most effective approach in HIV infection in pregnancy.
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