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Prophylaxis and treatment of HIV-1 infection in pregnancy: Swedish recommendations 2013.

Journal article
Authors Lars Navér
Jan Albert
Ylva Böttiger
Christina Carlander
Leo Flamholc
Magnus Gisslén
Filip Josephson
Olof Karlström
Lena Lindborg
Veronica Svedhem-Johansson
Bo Svennerholm
Anders Sönnerborg
Aylin Yilmaz
Karin Pettersson
Published in Scandinavian journal of infectious diseases
Volume 46
Issue 6
Pages 401-11
ISSN 1651-1980
Publication year 2014
Published at Institute of Biomedicine, Department of Infectious Medicine
Pages 401-11
Language en
Links dx.doi.org/10.3109/00365548.2014.89...
Keywords Anti-HIV Agents, therapeutic use, Female, HIV Infections, drug therapy, prevention & control, transmission, Humans, Infectious Disease Transmission, Vertical, prevention & control, Post-Exposure Prophylaxis, Practice Guidelines as Topic, Pregnancy, Pregnancy Complications, Infectious, drug therapy, prevention & control, Sweden
Subject categories Infectious Medicine, Obstetrics and women's diseases

Abstract

Prophylaxis and treatment with antiretroviral drugs and elective caesarean section delivery have resulted in very low mother-to-child transmission of HIV during recent years. Updated general treatment guidelines and increasing knowledge about mother-to-child transmission have necessitated regular revisions of the recommendations for the prophylaxis and treatment of HIV-1 infection in pregnancy. The Swedish Reference Group for Antiviral Therapy (RAV) updated the recommendations from 2010 at an expert meeting on 11 September 2013. The most important revisions are the following: (1) ongoing efficient treatment at confirmed pregnancy may, with a few exceptions, be continued; (2) if treatment is initiated during pregnancy, the recommended first-line therapy is essentially the same as for non-pregnant women; (3) raltegravir may be added to achieve rapid reduction in HIV RNA; (4) vaginal delivery is recommended if at > 34 gestational weeks and HIV RNA is < 50 copies/ml and no obstetric contraindications exist; (5) if HIV RNA is < 50 copies/ml and delivery is at > 34 gestational weeks, intravenous zidovudine is not recommended regardless of the delivery mode; (6) if HIV RNA is > 50 copies/ml close to delivery, it is recommended that the mother should undergo a planned caesarean section, intravenous zidovudine, and oral nevirapine, and the infant should receive single-dose nevirapine at 48-72 h of age and post-exposure prophylaxis with 2 drugs; (7) if delivery is preterm at < 34 gestational weeks, a caesarean section delivery should if possible be performed, with intravenous zidovudine and oral nevirapine given to the mother, and single-dose nevirapine given to the infant at 48-72 h of age, as well as post-exposure prophylaxis with 2 additional drugs.

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