Page 136 - HIV/AIDS Guidelines

• potential ARV-associated adverse effects in pregnant women and the woman’s ability to adhere to a
particular regimen during pregnancy;
• potential short- and long-term effects of the ARV on the fetus and newborn, which are unknown for
many drugs.

Combination drug regimens are considered the standard of care in pregnancy, both for the treatment of HIV
infection and for the prevention of perinatal transmission of HIV. ZDV by intravenous infusion to the mother
during labor and neonatal ZDV prophylaxis for 6 weeks are recommended irrespective of antenatal regimen
chosen. Recommendations on ARV choice in pregnancy are discussed in detail in the Perinatal Guidelines
(see Perinatal Guidelines ).
1
Clinicians who are treating HIV-infected pregnant women are strongly encouraged to report cases of prenatal
exposure to ARVs (either administered alone or in combinations) to the Antiretroviral Pregnancy Registry
(http://www.apregistry.com). The registry collects observational data regarding exposure to Food and Drug
Administration (FDA)-approved ARV drugs during pregnancy for the purpose of assessing potential
teratogenicity. For more information regarding selection and use of ART during pregnancy, refer to the
Perinatal Guidelines. 1

Postpartum Management
Following delivery, clinical, immunologic, and virologic follow-up should continue as recommended for
non-pregnant adults and adolescents. Because maternal ART reduces but does not eliminate the risk of
transmission of HIV in breast milk and postnatal transmission can occur despite maternal ART, women
should also be counseled to avoid breastfeeding. HIV-infected women should avoid premastication of food
1
for the infant because the practice has been associated with transmission of HIV from mother to child. 39
Considerations regarding continuation of ART for maternal therapeutic indications are the same as
considerations regarding ART use for other non-pregnant individuals. For more information regarding
postpartum discontinuation of ART, refer to the Perinatal Guidelines. Several studies have demonstrated that
1
women’s adherence to ART may worsen in the postpartum period. 40-44 Clinicians caring for postpartum
women receiving ART should specifically address adherence, including evaluating specific facilitators and
barriers to adherence, and consider offering an adherence intervention (see Adherence to Antiretroviral
Therapy).

References

1. Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for
Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce
Perinatal HIV Transmission in the United States, Sep. 14, 2011; pp 1-207. Available at
http://aidsinfo.nih.gov/contentfiles/PerinatalGL.pdf. 2011.

2. Collazos J, Asensi V, Carton JA. Sex differences in the clinical, immunological and virological parameters of HIV-
infected patients treated with HAART. AIDS. Apr 23 2007;21(7):835-843.

3. Fardet L, Mary-Krause M, Heard I, Partisani M, Costagliola D. Influence of gender and HIV transmission group on
initial highly active antiretroviral therapy prescription and treatment response. HIV Med. Nov 2006;7(8):520-529.
4. Currier J, Averitt Bridge D, Hagins D, et al. Sex-based outcomes of darunavir-ritonavir therapy: a single-group trial. Ann
Intern Med. Sep 21 2010;153(6):349-357.
5. Clark RA, Squires KE. Gender-specific considerations in the antiretroviral management of HIV-infected women. Expert
Rev Anti Infect Ther. Apr 2005;3(2):213-227.

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents I-20

Downloaded from http://aidsinfo.nih.gov/guidelines on 12/8/2012 EST.