title: Antiretroviral use during pregnancy for treatment or prophylaxis.
abstract: BACKGROUND
  Antiretrovirals are recommended for all pregnant women either for treatment of HIV-1 infection or for prevention of mother-to-child transmission. Distinguishing between HIV-1-infected pregnant women who meet treatment criteria and those who do not (who use antiretrovirals during pregnancy for prophylaxis) is accomplished by assessing the HIV-1 disease stage and has important implications regarding when antiretroviral drugs are initiated during pregnancy, what drugs are used and antiretroviral use after delivery.
  
  
  METHODS
  This review addresses antiretroviral use by HIV-1-infected women during pregnancy. Specifically, the review focuses on antiretroviral therapy for HIV-1-infected pregnant women who meet criteria for treatment and antiretroviral prophylaxis for HIV-1-infected pregnant women (to prevent mother-to-child transmission of HIV-1). The review primarily addresses antiretroviral use in resource-rich settings, but use in resource-poor settings is briefly addressed.
  
  
  CONCLUSIONS
  Antiretrovirals represent only one component of the overall management of HIV-1 infected pregnant women and, therefore, cannot be viewed in isolation from other components of optimal care for HIV-1-infected women and from other efficacious interventions to prevent mother-to-child transmission of HIV-1. Antiretrovirals can be used safely and effectively during pregnancy. We concur with current guidelines regarding the threshold that differentiates which women need antiretroviral therapy for HIV-1 infection for their own health versus those who need prophylaxis to prevent transmission of HIV-1 infection to their child. We thus recommend that lifelong antiretroviral therapy be initiated in patients with an AIDS-defining illness, a CD4 count < 350 cells/mm(3) or other co-morbid conditions such as acute opportunistic infections, HIV-1-associated nephropathy or hepatitis B co-infection. Irrespective of whether or not antiretrovirals are used during pregnancy, or whether antiretrovirals during pregnancy are used for treatment or prophylaxis, all infants of HIV-1-infected women should receive antiretroviral post-exposure prophylaxis.
authors.affiliation: Medicine/Infectious Diseases, Santa Clara Valley Medical Center, Ira Greene PACE Clinic, 751 S. Bascom Avenue, San Jose, CA 95128 , USA.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Sturt
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Read
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use; D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016903:Drug Monitoring; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000628:therapy / Q000635:transmission*; D015497:HIV-1; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000517:prevention & control; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D055118:Medication Adherence; D056990:Post-Exposure Prophylaxis; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000628:therapy; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents