title: Prophylaxis and treatment of HIV-1 infection in pregnancy: Swedish recommendations 2013.
abstract: Prophylaxis and treatment with antiretroviral drugs and elective caesarean section delivery have resulted in very low mother-to-child transmission of HIV during recent years. Updated general treatment guidelines and increasing knowledge about mother-to-child transmission have necessitated regular revisions of the recommendations for the prophylaxis and treatment of HIV-1 infection in pregnancy. The Swedish Reference Group for Antiviral Therapy (RAV) updated the recommendations from 2010 at an expert meeting on 11 September 2013. The most important revisions are the following: (1) ongoing efficient treatment at confirmed pregnancy may, with a few exceptions, be continued; (2) if treatment is initiated during pregnancy, the recommended first-line therapy is essentially the same as for non-pregnant women; (3) raltegravir may be added to achieve rapid reduction in HIV RNA; (4) vaginal delivery is recommended if at > 34 gestational weeks and HIV RNA is < 50 copies/ml and no obstetric contraindications exist; (5) if HIV RNA is < 50 copies/ml and delivery is at > 34 gestational weeks, intravenous zidovudine is not recommended regardless of the delivery mode; (6) if HIV RNA is > 50 copies/ml close to delivery, it is recommended that the mother should undergo a planned caesarean section, intravenous zidovudine, and oral nevirapine, and the infant should receive single-dose nevirapine at 48-72 h of age and post-exposure prophylaxis with 2 drugs; (7) if delivery is preterm at < 34 gestational weeks, a caesarean section delivery should if possible be performed, with intravenous zidovudine and oral nevirapine given to the mother, and single-dose nevirapine given to the infant at 48-72 h of age, as well as post-exposure prophylaxis with 2 additional drugs.
authors.affiliation: From the Department of Paediatrics, Karolinska University Hospital , Stockholm , Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Navér
authors.forename: Jan
authors.initials: J
authors.lastname: Albert
authors.forename: Ylva
authors.initials: Y
authors.lastname: Böttiger
authors.forename: Christina
authors.initials: C
authors.lastname: Carlander
authors.forename: Leo
authors.initials: L
authors.lastname: Flamholc
authors.forename: Magnus
authors.initials: M
authors.lastname: Gisslén
authors.forename: Filip
authors.initials: F
authors.lastname: Josephson
authors.forename: Olof
authors.initials: O
authors.lastname: Karlström
authors.forename: Lena
authors.initials: L
authors.lastname: Lindborg
authors.forename: Veronica
authors.initials: V
authors.lastname: Svedhem-Johansson
authors.forename: Bo
authors.initials: B
authors.lastname: Svennerholm
authors.forename: Anders
authors.initials: A
authors.lastname: Sönnerborg
authors.forename: Aylin
authors.initials: A
authors.lastname: Yilmaz
authors.forename: Karin
authors.initials: K
authors.lastname: Pettersson
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D056990:Post-Exposure Prophylaxis; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000517:prevention & control*; D013548:Sweden
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; follow-up; mode of delivery; mother-to-child transmission; pregnancy; prophylaxis