Sixth International Congress Drug Therapy in HIV Infection 17-21 November, 2002 Glasgow, UK

Advances in the management of HIV in pregnancy have lead to large reductions in the mother-to-child transmission (MTCT) rate in countries where these interventions are accessible. Clinical trials and a number of observational studies have shown that overall rates can be reduced to below 2%. Maternal viral load at time of delivery is a strong predictor of transmission but the importance of postnatal therapy to the neonate (post exposure prophylaxis) is increasingly being recognised. Whether caesarean section delivery gives additional protection to women on HAART with undetectable viral loads remains unanswered. Studies in Europe and US have shown little effect of pregnancy on HIV disease progression. The situation may be different in developing countries where pregnancy may accelerate HIV disease.

In resource poor settings there have been trials of short course antiretroviral regimens in breastfeeding and non-breastfeeding populations. Reductions in transmissions seen at 6 weeks post delivery (rates between 8-12%) are lost by 18 months due to transmissions via breastfeeding. Maternal morbidity and mortality affect child health and mortality. There are limitations in solely considering MTCT as an end goal in resource poor settings and programmes to extend HIV treatment and care through to mothers and families are commencing.

Until a viable, commercially available vaginal microbicide becomes available, barrier contraception methods remain the safest method to prevent the acquisition of HIV and other sexually transmitted infections. The additional use of hormonal contraception gives further protection against unplanned pregnancies. There are several theoretical reasons why hormonal contraception may interact with HIV and several studies have shown an increased risk of acquisition in oral contraceptive pill users. In women who are already infected, hormonal contraception usage is further compounded by interactions with non-nucleoside RT inhibitors, protease inhibitors and other medications.

HIV reduces fertility in women. The ongoing management of couples desiring children requires sensitive counselling and discussion of choices and interventions to aid safe conception and lead to healthy mothers and infants.

Presenting author: Ade Fakoya

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1 Newham General Hospital, London, United Kingdom.

2002-11-17
PL11-1

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