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U.S. Panel Releases Updated Pregnancy and Perinatal HIV Treatment Guidelines

SUMMARY: On May 24, the U.S. Department of Health and Human Services (DHHS) released the latest revision of federal treatment guidelines for pregnant women with HIV. Antiretroviral therapy during pregnancy is intended both to benefit the woman's health and to prevent transmission of HIV to the baby. The update does not include major changes to prior recommendations, but features a new rating system (similar to the adult guidelines) and adds further information about drug resistance, treatment of HIV/HBV coinfected pregnant women, safe delivery methods, and the potential for infant cardiac toxicity with ritonavir-boosted protease inhibitors (PIs).

By Liz Highleyman

Below is the text of an announcement from the DHHS AIDSInfo service summarizing the changes.

The complete pregnancy and perinatal guidelines are available online at www.aidsinfo.nih.gov/ContentFiles/PerinatalGL.pdf.

Updated Perinatal Treatment Guidelines Now Available

AIDSinfo announces the release of the updated Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States.

Key issues and new information discussed in the guidelines include:

Introduction of rating of recommendations based on strength of recommendation and quality of evidence.
Update on recent international clinical trials, including trials of prevention of postnatal transmission and drug resistance in infants infected despite infant or maternal antiretroviral prophylaxis of postnatal infection.
New discussion of the categories and the criteria used for recommendations about use of specific drugs or drug regimens in pregnancy.
Additional discussion of options for antiretroviral prophylaxis when an HIV/HBV coinfected pregnant woman does not require antiretroviral therapy for her own health or treatment for hepatitis B disease.
Discussion of stopping NNRTI-based regimens and strategies to reduce the risk of resistance, including short-term continuation of a NRTI component or switching to a PI prior to discontinuing therapy.
Updated information on combination antiretroviral drug use and pregnancy outcome and nevirapine hepatic toxicity in pregnancy.
New information regarding resistance following discontinuation of triple drug prophylaxis after delivery and new information from clinical trials on response to therapy following single-dose nevirapine exposure.
New references on use of dual NRTI "tail" to reduce risk of nevirapine [Viramune] resistance.
Reorganization and update of Mode of Delivery section.
Caution on use of lopinavir-ritonavir [Kaletra] (and other boosted PIs) in newborns, particularly preterm infants, due to reports of cardiac toxicity (heart block).
Discussion of new data on feeding infants premasticated food and risk of HIV transmission.
Contact information for the National Perinatal HIV Hotline.

New information is highlighted in yellow throughout the text and in tables.

The updated guidelines and a separate PDF file of all tables can be downloaded from the Perinatal Guidelines section of AIDSinfo. You may also go to the AIDSinfo Order Publications page to request the guidelines via e-mail.

Your Feedback Is Important

The HHS Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission welcomes feedback on the latest revisions to the Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. Please send your comments with the subject line "Perinatal Comments" to ContactUs@aidsinfo.nih.gov by June 7, 2010.

5/28/10

Reference
Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. May 24, 2010.

Other source
U.S. DHHS. Updated Perinatal Treatment Guidelines Now Available AIDSinfo At-a-Glance 21. May 24, 2010.

 

 

 

 

 

 

 

 

 

 

 

 

 

 


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