|
Testing: Since HIV–infected mothers can pass the virus to their baby during pregnancy, labor, delivery or breastfeeding, the U.S. Centers for Disease Control and Prevention (CDC) recommends that all pregnant women get tested for HIV. Without knowledge of their positive HIV status, infected mothers are not presented with options that may prevent their babies from acquiring HIV. Antiretroviral therapy: Antiretroviral drugs are used to suppress HIV. These drugs slow down the time it takes the virus to replicate and inhibit its ability to infect new cells. Antiretroviral therapy can significantly reduce the likelihood of an HIV–infected pregnant mother passing the virus to her baby. Patients who were taking antiretroviral medication before becoming pregnant should talk to their healthcare providers to determine the safest and most effective treatment option. In general, efavirenz (Sustiva ®), stavudine (Zerit ®), hydroxyurea (Droxia ® or Hydrea ®), and the oral liquid formulation of amprenavir (Agenerase ®) should not be taken during pregnancy because they may cause harm to the fetus. Combination antiretroviral therapy with zidovudine (Retrovir ®) and other antiretrovirals is the standard preventative treatment prescribed to HIV–infected pregnant women. Zidovudine is considered the most effective antiretroviral at preventing HIV transmission from mother to child. Treatment begins after the first trimester (14–34 weeks into pregnancy), when the baby is less susceptible to harmful side effects of the drug. The exact combination and dosage varies among patients, depending on their overall health and severity of their HIV infections. The newborn typically receives oral zidovudine every six hours for six weeks after birth. Perinatal (shortly before or after birth) HIV infection rates have shown to drop to as low as one to two percent for babies if their mothers take combination antiretroviral therapy during pregnancy, as well as zidovudine or nevirapine (Viramune ®) preventative therapy during labor and after birth. Zidovudine may also be prescribed alone to prevent transmission from an HIV–infected pregnant woman to her baby. However, taking the drug alone is typically less effective at reducing the viral load than combination therapy with other antiretrovirals. Taking only one antiretroviral also increases the risk of developing drug resistance. Once drug resistance occurs, the particular drug can no longer suppress the virus, even if it is taken in the future. This treatment is usually administered after 28 weeks of pregnancy in women who have low levels of HIV in the blood and who are concerned about the side effects antiretrovirals may have on the baby. A single dose of nevirapine and zidovudine is then taken during labor. Baby formulas: HIV–infected mothers should not breastfeed their babies because the virus may be transmitted via the breast milk. Instead, baby formulas should be used. Cesarean sections: The baby is more likely to become infected if the vaginal delivery takes a long time because the newborn is exposed to the mother's blood and vaginal secretions. Mothers with a high viral load (high levels of the virus in their blood) might reduce their risk if they deliver their baby by cesarean section (surgical delivery of an infant), also called C–section. While a C–section can reduce the risk of transmission during birth, it is not typically necessary in patients who undergo antiretroviral therapy. Counseling: Prevention counseling is not mandatory, but it should be offered to all women when they receive their HIV test results. Counseling should focus on reducing the risk of HIV infection or transmission, including vertical transmission. In addition, the counselor should also suggest achievable behavior changes that will help reduce the patient's risk of developing or transmitting HIV. The counseling session is a chance to clear up any misconceptions or questions the patient has about the disease.
 |
Learn
