title: [HIV and pregnancy: 2013 guidelines from the French expert working group].
abstract: With effective antiretroviral therapy, the risk of mother to child transmission (MTCT) is now under 1%. The 2013 French guidelines emphasize early antiretroviral lifelong antiretroviral therapy. Thus, the current trend for women living with HIV is to take antiretroviral therapy before, during and after their pregnancies. A major issue today is the choice of antiretroviral drugs, to maximize the benefits and minimize the risks of fetal exposure. This requires interdisciplinary care. The use of effective therapies permits gradual but profound changes in obstetric practice. When maternal plasma viral load is controlled (<50 copies/ml), obstetrical care can be more similar to standards in HIV-negative women. Prophylactic cesarean section is recommended when the viral load in late pregnancy is above 400 copies/mL. Intravenous zidovudine during labor is recommended only if the last maternal viral load is>400 copies/mL or in case of complications such as preterm delivery, bleeding or chorio-amnionitis during labor. In case of premature rupture of membranes before 34 weeks, a multidisciplinary decision should be made, based on gestational age and control of maternal viral load; if the woman is under antiretroviral therapy and especially if her viral load is undetectable, steroids and antibiotics should be offered and pregnancy can be continued except in case of signs or symptoms of chorio-amnionitis. Breastfeeding is not recommended in women living with HIV in France, as in industrialized countries. Prophylaxis in the newborn is usually zidovudine for 1 month. In case of significant exposure to HIV perinatally, in particular when, maternal viral load is>1000 copies/mL, prophylactic combination therapy is recommended. Monitoring of the child is necessary to determine whether or not it is free of HIV infection and to monitor possible adverse effects of perinatal exposure to antiretroviral drugs.
authors.affiliation: Service de gynécologie-obstétrique, hôpital Louis-Mourier, AP-HP, université Paris-Diderot, 178, rue des Renouillers, 92700 Colombes, France. Electronic address: laurent.mandelbrot@lmr.aphp.fr.
authors.forename: L
authors.initials: L
authors.lastname: Mandelbrot
authors.affiliation: Service de gynécologie-obstétrique, centre hospitalier universitaire, 31059 Toulouse, France.
authors.forename: A
authors.initials: A
authors.lastname: Berrébi
authors.affiliation: Service de maladies infectieuses, CHU Bichat-Claude-Bernard, 75018 Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Matheron
authors.affiliation: Service dimmuno-hématologie pédiatrique, CHU Necker-Enfants-Malades, 75015 Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Blanche
authors.affiliation: Service de maladies infectieuses, CHU Pitié-Salpêtrière, 75013 Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Tubiana
authors.affiliation: Service de virologie, CHU Necker-Enfants-Malades, 75015 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Rouzioux
authors.affiliation: Service de gynécologie-obstétrique, CHU Bichat, 75018 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Faucher
authors.affiliation: Service de médecine, centre hospitalier universitaire, 67091 Strasbourg, France.
authors.forename: M
authors.initials: M
authors.lastname: Partisani
authors.affiliation: Association AIDES, 75019 Paris, France.
authors.forename: V
authors.initials: V
authors.lastname: Boyer
authors.affiliation: Association ARCAT, 75020 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Taeron
authors.affiliation: Service de pédiatrie, CHU Robert-Debré, 75019 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Faye
authors.affiliation: Biologie de la reproduction, centre hospitalier universitaire, 31059 Toulouse, France.
authors.forename: L
authors.initials: L
authors.lastname: Bujan
authors.affiliation: Inserm U897, université Bordeaux-2, 33076 Bordeaux, France.
authors.forename: F
authors.initials: F
authors.lastname: Dabis
authors.affiliation: Inserm U1022, 94276 Le Kremlin-Bicêtre, France.
authors.forename: J
authors.initials: J
authors.lastname: Warszawski
authors.affiliation: Service de maladies infectieuses, hôpital Saint-André/CHU, 33000 Bordeaux, France.
authors.forename: P
authors.initials: P
authors.lastname: Morlat
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*
chemical_list: D044966:Anti-Retroviral Agents
keywords: Accouchement; Antiretroviral therapy; Antirétroviraux; Childbirth; French guidelines; Grossesse; HIV; Pregnancy; Recommandations; VIH