Antiretroviral Therapy in HIV-infected Pregnant Women

Abstract

The use of antiretroviral therapy in pregnancy has changed dramatically in the past five years. This article reviews these developments. The use of zidovudine monotherapy in pregnancy, during delivery and given post-natally to the infant for the reduction of maternal-infant transmission has been evaluated. In a placebo-controlled double-blinded method, a significant reduction in maternal-infant transmission, from 25 to eight percent, was found. Triple antiretrovirals with newer agents from different drug families are now recommended as the optimal therapy for adults. Therapy is directed by the adults HIV viral load and by their CD4 count as measures of viral activity and immune compromise, respectively. Given these changes in adult therapy, treatment of the pregnant woman is undergoing re-evaluation. It is now considered to be in the best interest of the mother to consider full triple antiretroviral therapy during pregnancy or to continue antiretroviral therapy if pregnancy occurs while a woman is taking this treatment. It is of great concern that there is minimal information about the safety of these drugs used during pregnancy. A review of each of the currently available antiretroviral drugs in pregnancy is presented here. It is strongly recommended that any health care provider caring for an HIV-infected pregnant woman, or an HIV-infected woman who could become pregnant, be aware of the issues and concerns around combination antiretrovirals in pregnancy. Consultation with experts in this area is recommended.