Important note: Information in this article was accurate in 2000. The state of the art may have changed since the publication date.
The efficacy and tolerability of combination antiretroviral therapy in pregnancy: infant and maternal outcome.
Int J STD AIDS. 2000 Apr;11(4):220-3. Unique Identifier : AIDSLINE MED/20233038 Clarke SM; Mulcahy F; Healy CM; Condon S; Butler KM; Department of Genito-Urinary Medicine, St James' Hospital,; Dublin, Ireland. gum@stjames.ie
Abstract:
Antiretroviral therapy (ART) and Caesarean section (CS) delivery significantly reduce the risk of vertically transmitted HIV infection. Attention must focus on determining the optimal management strategy for HIV-positive pregnancies. Guidelines must reflect not only the activity and tolerability of combination ART in pregnancy for mother and infant and the potential short and long-term infant toxicity, but also whether surgical delivery can confer an added benefit if combination ART had reduced plasma viraemia to undetectable levels. To aid the development of management strategies for the Republic of Ireland, a retrospective detailed review of all HIV-positive pregnancies since the introduction of combination ART was undertaken. Since 1997 there have been 25 deliveries to 24 women. Combination ART reduced plasma viraemia to undetectable levels in 76% mothers at delivery. The CS rate was 28% and no unanticipated infant toxicity was encountered. To date no infant has proven infected. Three infants have seroreverted and 24 of 26 infants have had at least 2 negative HIV ribonucleic acid (RNA) and polymerase chain reaction (PCR) tests. Two infants are less than one month old. In this study, the CS rate of 28% is below that reported from many centres yet no vertical transmission was found. Given the efficacy of ART in reducing plasma viraemia, the additional benefit of CS for these women is questionable.
Keywords: JOURNAL ARTICLE Adolescence Adult Anti-HIV Agents/ADVERSE EFFECTS/*THERAPEUTIC USE Drug Therapy, Combination Female Human HIV Infections/*DRUG THERAPY/IMMUNOLOGY/VIROLOGY HIV Protease Inhibitors/ADVERSE EFFECTS/*THERAPEUTIC USE *HIV-1/GENETICS Indinavir/ADVERSE EFFECTS/THERAPEUTIC USE Infant Lamivudine/ADVERSE EFFECTS/*THERAPEUTIC USE Male Nelfinavir/ADVERSE EFFECTS/THERAPEUTIC USE Nevirapine/ADVERSE EFFECTS/THERAPEUTIC USE Pregnancy Pregnancy Outcome Reverse Transcriptase Inhibitors/ADVERSE EFFECTS/*THERAPEUTIC USE Ritonavir/ADVERSE EFFECTS/THERAPEUTIC USE Saquinavir/ADVERSE EFFECTS/THERAPEUTIC USE Treatment Outcome Zidovudine/ADVERSE EFFECTS/*THERAPEUTIC USE
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Important note: Information in this article was accurate in 2000. The state of the art may have changed since the publication date.
