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HIV and pregnancy: screening and management update

Giles, Michelle

Current Opinion in Obstetrics & Gynecology: April 2009 - Volume 21 - Issue 2 - p 131–135
doi: 10.1097/GCO.0b013e3283294967
Maternal-fetal medicine: Edited by James F. Smith

Purpose of review: To review recent publications in the area of HIV and pregnancy regarding screening and management.

Recent findings: There has recently been a renewed interest in mandatory antenatal HIV testing in pregnancy. There is emerging data that the risk of HIV transmission from mother to child is associated with late initiation of therapy during pregnancy and a diminishing importance of intrapartum zidovudine in women with an undetectable viral load at delivery. Publications, predominantly from cohort studies, continue to demonstrate no difference in HIV transmission rates in women with undetectable viral loads according to the mode of delivery but do confirm an increase in morbidity associated with caesarean section. New studies of continuation of antiretroviral prophylaxis to infants with ongoing exposure to HIV-infected breast milk are encouraging although may be associated with increased toxicity and resistance.

Summary: With over 420 000 children newly diagnosed with HIV in 2007, there is an urgent need to continue research to better understand optimal antenatal screening policy, optimal antiretroviral therapy within available resources, preferred mode of delivery considering morbidity and HIV transmission and finally, new methods to protect breastfed children from infection.

Infectious Diseases Unit, The Alfred Hospital, Melbourne, Victoria, Australia

Correspondence to Dr Michelle Giles, Infectious Diseases Unit, The Alfred Hospital, 2nd Floor, Burnet Institute, 85 Commercial Road, Melbourne, VIC 3004, Australia Tel: +61 3 9076 5132; e-mail: m.giles@alfred.org.au

© 2009 Lippincott Williams & Wilkins, Inc.