Canadian consensus guidelines for the management of pregnancy, labour and delivery and for postpartum care in HIV-positive pregnant women and their offspring (summary of 2002 guidelines)
Recommendations for antiretroviral treatment for an HW-infected pregnant woman are based on the principle that therapies of known benefit to the woman should be offered and not withheld during pregnancy. Women should ideally receive optimal antiretroviral therapy regardless of pregnancy status. Whil...
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| Published in: | Canadian Medical Association journal (CMAJ) 2003-06, Vol.168 (13), p.1671-1674 |
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| Main Authors: | , , , , , , , |
| Format: | Article |
| Language: | eng |
| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Recommendations for antiretroviral treatment for an HW-infected pregnant woman are based on the principle that therapies of known benefit to the woman should be offered and not withheld during pregnancy. Women should ideally receive optimal antiretroviral therapy regardless of pregnancy status. While optimizing maternal care and health is of prime importance, it is also clear that we must, whenever possible, minimize the exposure of the developing fetus to potentially toxic medications. The data currently available on the pharmacokinetics and safety of antiretroviral drugs in pregnancy are minimal, and therefore all treatment decisions during pregnancy require full discussion between the patient and her physician with regard to the known and potential benefits and risks. It is not clear at present whether pregnancy increases the risk of toxic effects such as the lactic acidosis - hepatic steatosis syndrome that has been associated with nucleoside analogue therapy.5 However, the recent enhanced appreciation of the risk of serious side effects and toxic effects associated with these drugs, as well as their potential for mitochondrial toxicity, simply strengthens the argument that the management of antiretrovirals in pregnancy requires specialized expertise. Physicians caring for HIV-infected pregnant women need to be alert to complications such as lactic acidosis. Careful monitoring of hepatic enzymes and electrolytes and assessment of any new symptoms are imperative. Optimal care should involve the woman herself, an HIV specialist, an HIV-experienced obstetrician and a pediatric HIV specialist. The assistance of pharmacists and dietitians with HIV expertise is also invaluable. Over 19 million women are infected with HIV world wide and, as we become better at treating their disease, they are living longer and healthier lives. Some choose to become pregnant, whereas for other HIV-positive women pregnancy is an unplanned circumstance with which they must cope. Perinatal transmission from mother to child is an important source of HIV infection, but this can be ameliorated with the proper treatment of mother and child. [David R. Burdge] and colleagues present Canadian consensus guidelines that provide evidence-based recommendations to practitioners involved in all stages of pregnancy management of HIV-positive patients, including proper care for their infants. In an associated piece in the Practice section, these authors outline 7 common clinical scenarios and d |
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| ISSN: | 0820-3946 1488-2329 |