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


RESULTS
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.


CONCLUSIONS
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.
Giles
Michelle
M
Infectious Diseases Unit, The Alfred Hospital, Melbourne, Victoria, Australia. scott.roberts@utsouthwestern.edu
D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001942:Breast Feeding / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008403:Mass Screening / Q000379:methods; D009774:Obstetrics / Q000379:methods; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000628:therapy*; D012306:Risk; D016896:Treatment Outcome; D015215:Zidovudine / Q000627:therapeutic use
D019380:Anti-HIV Agents; D015215:Zidovudine