Management of HIV During Pregnancy

According to UNAIDS, in 2015, one hundred and fifty thousand children were infected by HIV worldwide, therefore the use of antiretroviral therapy (ARV) during pregnancy is an important development for the reduction of maternal-fetal transmission. The treatment of a pregnant woman is done by combining two different ARV classes. The combination of two nucleoside reverse transcriptase inhibitors (NRTIs) with one non-nucleoside reverse transcriptase inhibitor (NNRTI) or protease inhibitor (PI) is generally recommended. The association of tenofovir/lamivudine (TDF/3TC) is the primary choice among the NRTIs, and zidovudine/lamivudine (AZT/3TC) is an alternative association although there is evidence showing that the use of AZT may be related to maternal and fetal anemia. Among the NNRTIs, the recommended drug is efavirenz, and nevirapine is the alternative drug. Treatment strategies with a PI drug must be associated with ritonavir so as to increase the serum levels of the drug and to therefore diminish the risk of viral resistance against the PI class. The main concern regarding the PI class is the increased risk of premature birth and low birth weight. The delivery method used depends on the viral load and the gestational age. When the maternal viral load is unknown or ≥1000 copies/ml, a C-section is recommended. When the viral load is undetectable or ≤1000 copies/ml, vaginal birth is a possibility. Elective C-section is often effective in preventing the vertical transmission of HIV in women who did not take ARV during the pregnancy or in those who only took AZT.