Guidelines for the management of HIV infection in pregnant women and the prevention of mother‐to‐child transmission of HIV

Abstract

transmission – background The prevalence of HIV infection amongst women giving birth in England and Wales has increased every year since 1990. Results from the Unlinked Anonymous Surveys of HIV infection in pregnancy, show that in 2003, the prevalence reached one in 180 (0.56%) in inner London, one in 271 in outer London (0.37%) and one in 1282 (0.08%) in the rest of England [1]. The majority of these women are from sub-Saharan Africa. The Department of Health policy of recommending an HIV test to every pregnant woman [2] has resulted in an increase in the proportion of these women who are aware of their diagnosis prior to delivery (more than 80 % in London in 2001) and a decrease in the absolute number of infants infected in the UK [3]. In untreated women the risk of transmission is related to maternal health, obstetric factors and infant prematurity. Overall there is a close linear correlation between maternal viral load and risk of transmission but rare transmissions have been reported even at plasma viraemia less than 400 RNA copies/mL [4]. CD4 counts and clinical disease stage have been shown in some cohorts to have an association with the risk of transmission even after controlling for viral load. The only obstetric factors that consistently show an association with risk of transmission are mode of delivery and duration of membrane rupture, but invasive procedures in labour are generally avoided as they pose a theoretical risk of iatrogenic transmission. Delivery before 34 weeks of gestation has been shown to be associated with an increased risk of transmission. There are still relatively few, and often conflicting data, on the safety of antiretroviral therapy (ART) in pregnancy, and the management of any HIV-positive pregnant woman