Prophylaxis and treatment of HIV-1 infection in pregnancy: Swedish Recommendations 2010

Abstract

Prophylaxis and treatment with antiretroviral drugs and the use of elective caesarean section have resulted in a very low mother-to-child transmission of human immunodeficiency virus (HIV) during recent years. The availability of new antiretroviral drugs, updated general treatment guidelines and increasing knowledge of the importance of drug resistance, have necessitated regular revisions of the “Prophylaxis and treatment of HIV-1 infection in pregnancy” recommendations. For these reasons, The Swedish Reference Group for Antiviral Therapy (RAV) updated the 2007 recommendations at an expert meeting that took place on 25 March 2010. The most important revisions from the previous recommendations are: (1) it is recommended that treatment during pregnancy starts at the latest at gestational week 14–18; (2) ongoing efficient treatment at confirmed pregnancy may, with a few exceptions, be continued; (3) lopinavir/r and atazanavir/r are equally recommended protease inhibitors; (4) if maternal HIV RNA is >50 copies/ml close to delivery, a planned caesarean section, intravenous zidovudine, oral nevirapine for the mother and post-exposure prophylaxis for the infant with 3 antiretroviral drugs are recommended; (5) for delivery at <34 gestational weeks, intravenous zidovudine and oral nevirapine for the mother and at 48–72 h for the infant is recommended, in addition to other prophylaxis; (6) intravenous zidovudine is not recommended when HIV RNA is <50 copies/ml and a caesarean section is performed; (7) it is recommended that prophylaxis for the infant is started within 4 h; (8) prophylactic zidovudine for the infant may be administered twice daily instead of 4 times a day, as was the case previously; and (9) the number of sampling occasions for the infant has been decreased.

Keywords::

• HIV
• pregnancy
• mother-to-child transmission
• prophylaxis
• infant

Declaration of interest: AS has received research grants from Abbott, and Gilead Sciences. He has received honoraria as speaker and/or advisor from Abbott, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, and Pfizer.

AY has received honoraria as speaker and/or advisor from Abbott, Gilead Sciences and Tibotec.

KW has received research grants from Janssen-Cilag. She has received honoraria as speaker and/or advisor from Abbott, Gilead Sciences, Bristol-Myers Squibb and Tibotec.

LF has received honoraria as speaker and/or advisor from Abbott, Bioinvent, Boehringer-Ingelheim, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Merck, Pfizer, Roche and Tibotec.

LN has received honoraria as speaker from Abbott.

MG has received research grants from Abbott, Baxter, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Merck, Pfizer, Roche and Tibotec. He has received honoraria as speaker and/or advisor from Abbott, Bioinvent, Boehringer-Ingelheim, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Merck, Pfizer, Roche and Tibotec.

VS has received honoraria as speaker and/or advisor from Abbott, Bristol-Myers Squibb, GlaxoSmithKline, MSD and Roche.

EB, FJ, JA, KG, KP, OK and SL report no conflict of interest. The authors alone are responsible for the content of and writing of the paper.