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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
HIV Infection in Pregnancy
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5. Read the material on other antiretrovirals
In addition, antiretroviral monotherapy is now considered suboptimal for treatment, and combination drug therapy is the current standard of care. Pregnancy should not preclude the use of optimal therapeutic regimens. Two nucleoside analogue reverse transcriptase inhibitors comprise the currently most recommended standard initial treatment of H.I.V.-infected pregnant women. Combination "HAART" (Highly Active Anti-Retroviral Therapy) should be offered to all pregnant women whose clinical, immunologic, and virologic status indicate the need, and this therapy should be continued in the perinatal period. If the patient is currently on a regimen that does not contain zidovudine, it should be added during pregnancy. Because of issues of viral resistance, if the patient is on HAART, it should not be stopped during labor, but should be given orally with sips of water, even if cesarean is planned. Patient input is appropriate about continuing HAART during the first trimester as it is most likely in her best interest to continue, but the benefits and risks to the fetus remain unknown. Whether or not women are on HAART, they are advised not to breastfeed. Consultation with an infectious disease specialist is always appropriate.
The F.D.A. classifies most antiretrovirals as pregnancy category C, but benefits are considered to exceed risk in this situation. (Category C is defined as: "Safety in human pregnancy has not been determined, animal studies are either positive for fetal risk or have not been conducted, and the drug should not be used unless the potential benefit outweighs the potential risk to the fetus.") Teratogenicity or carcinogenicity has not been established for any of the commonly used anti-retroviral drugs. Nevertheless, consideration may be given to delaying initiation of therapy until after the first trimester. Discussion of treatment options should be non-coercive and the final decision is the responsibility of the woman.
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