title: The management of HIV-infected pregnant women.
abstract: OBJECTIVE
  The purpose of this article is to update the current practice in the management of HIV-infected pregnant women and present evidence-based recommendations for the reduction of mother-to-child transmission.
  
  
  RESULTS
  Early and sustained control of HIV viral replication is associated with decreasing residual risk of transmission and favors initiating antiretroviral drugs sufficiently early in naive women to suppress viral replication by the third trimester; however, this potential benefit must be balanced against the unknown long-term outcome of first-trimester drug exposure. Efavirenz should whenever possible be avoided in the first trimester of gestation, but its use seems well tolerated for 39 days after last menstrual period when the neural tube closes. Raltegravir may be considered in special circumstances in pregnancy.
  
  
  CONCLUSIONS
  The HIV viral load and the risk factors for prematurity must be considered when deciding when to start antiretroviral treatment in each individual pregnant woman. A ritonavir-boosted protease inhibitor combined with two nucleoside reverse transcriptase inhibitors is currently the most widely used regimen. Among protease inhibitors, lopinavir combined with ritonavir is the most frequently used; however, atazanavir combined with ritonavir is a good alternative. Elective cesarean section is the best delivery mode for pregnant women with viral loads more than 50  copies/ml.
authors.affiliation: Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil. senisejorge@gmail.com
authors.forename: Jorge
authors.initials: J
authors.lastname: Senise
authors.forename: Simone
authors.initials: S
authors.lastname: Bonafé
authors.forename: Adauto
authors.initials: A
authors.lastname: Castelo
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D006678:HIV / Q000502:physiology; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission / Q000821:virology; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents