Section 4: Mother-to-child transmission and pregnancy outcomes

Risk of MTCT

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module3.2-section4-2

ARVs used during pregnancy should be selected only if potential benefit justifies the potential risk3

1. Tubiana R, et al. 18th CROI 2011. Abstract 735; 2. Warszawski J, et al. AIDS 2008;22: 289–99; 3. SmPCs. Available at http://www.ema.europa.eu Accessed March 2011



Maternal delivery HIV RNA levels and ARV use are independently associated with perinatal transmission1

module3.2-section4-3

ARVs used during pregnancy should be selected only if potential benefit justifies the potential risk2

1. Cooper E, et al. JAIDS 2002;9:484–94; 2. SmPCs. Available at http://www.ema.europa.eu Accessed March 2011



Inclusion of AZT in regimens during pregnancy

ARVs used during pregnancy should be selected only if potential benefit justifies the potential risk4

SPC. Available at: http://www.medicines.org.uk/EMC/medicine/24327/SPC/Zidovudine+100mg+capsules/. Accessed March 2011
2. EACS guidelines. Available at: http://www.europeanaidsclinicalsociety.org/guidelinespdf/1_Treatment_of_HIV_Infected_Adults.pdf. Accessed March 2011
3. DHHS perinatal guidelines 2010. Available at: http://aidsinfo.nih.gov/contentfiles/PerinatalGL.pdf. Accessed March 2011
4. SmPCs. Available at http://www.ema.europa.eu Accessed March 2011



Pregnancy outcomes using non-AZT ART1

ARVs used during pregnancy should be selected only if potential benefit justifies the potential risk2

1. Tariq S, et al. CROI 2010. Abstract 895; 2. SmPCs. Available at http://www.ema.europa.eu Accessed March 2011



Is there an increased risk of pre-eclampsia in women with HIV?

ARVs used during pregnancy should be selected only if potential benefit justifies the potential risk4

Suy A, et al. AIDS 2006;20:59–66
2. Watts DH. Drug Saf 2006;29:467–90
3. Conde-Agudelo A, et al. Am J Obstet Gynecol.2008;198:7–22
4. SmPCs. Available at http://www.ema.europa.eu Accessed March 2011



ART, mode of delivery and MTCT rates

module3.2-section4-4

ARVs used during pregnancy should be selected only if potential benefit justifies the potential risk3

Townsend, et al. AIDS 2008;22:973-81
2. Tubiana R, et al CID 2010;50:585–96
3. SmPCs. Available at http://www.ema.europa.eu Accessed March 2011



Management of infant post-partum

1. de Ruiter A, et al. HIV Medicine 2008;9;452–502
2. DHSSPS guidelines for the management of the HIV-exposed infant. Available at: http://www.dhsspsni.gov.uk/hivpregnancyguidelines.pdf. Accessed March 2011



HIV transmission during breastfeeding1

1. de Ruiter A, et al. HIV Medicine 2008;9:452–502
2. Shapiro R, et al. NEJM 2010;362:2282–94



BHIVA recommendations for breastfeeding

Available at http://www.bhiva.org/documents/Guidelines/InfantFeeding/InfantFeedCons.pdf. Accessed March 2011



WHO recommendations for breastfeeding

Available at www.who.int/child_adolescent_health/documents/9789241599535/en/index.html. Accessed March 2011



Postpartum follow-up

DHHS Perinatal Guidelines. Available at http://aidsinfo.nih.gov/contentfiles/PerinatalGL.pdf. Accessed March 2011