General principles for therapy during pregnancy
Here is a synopsis of the major considerations for treatment of pregnant women who are HIV-positive, as published by the Centers for Disease Control and Prevention:
• Decisions about using antiretroviral drugs during pregnancy should be made by the woman only after providers have discussed the potential benefits and risks of therapy.
• Initial evaluation should include an assessment of HIV disease status and recommendations regarding antiretroviral treatment or alterations of her current antiretroviral regimen. Assessment should include CD4 count, viral load test, history of antiretroviral therapy, gestational age, and supportive care needs.
• Discussion about the use of antiretroviral drugs during pregnancy should include:
A. knowns and unknowns of effects of drugs on the fetus and newborn, including lack of long-term data on any drugs;
B. what is the recommended treatment for the health of HIV-positive women;
C. the effectiveness of AZT in reducing perinatal transmission, results of preclinical and animal studies, and available information on use of various antiretroviral agents during pregnancy.
• Discussion of treatment should not be coercive, with the final decision for treatment resting with the woman.
• A decision not to receive treatment should not result in punitive action or denial of care.
• Use of AZT alone should not be denied to a woman wishing to minimize exposure of her fetus to other antiretrovirals.
• A long-term treatment plan should be developed, including emphasis on importance of adhering to regimens.
• General counseling should include information on the risks of antiretroviral drugs, as well as how cigarette smoking, illicit drug use, and unprotected intercourse with multiple partners during pregnancy has been associated with risk for perinatal transmission.
• Women should be told that infected women in the United States should not breast-feed, and that this recommendation applies even for women taking antiretroviral treatment.
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