A Guide to Primary Care of People with HIV/AIDS - Canadian Public ...

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A Guide to Primary Care of People with HIV/AIDS Chapter 12: Family Planning and Pregnancy Where should prenatal exposure cases be reported? Cases of prenatal exposure should be reported to the Antiretroviral Pregnancy Registry. This registry collects anonymous observational data. The Registry can be contacted at: Antiretroviral Pregnancy Registry 115 N. Third St., Suite 28401 Wilmington, NC 28401 Tel: 800-258-4263 FAX: 800-800-1052 KEY POINTS All HIV-positive women of childbearing age should receive information about the impact of HIV on the course and outcome of pregnancy, the impact of pregnancy on HIV progression, and appropriate contraception to prevent unintended pregnancy. To assure early identification of pregnancy in women with HIV who are sexually active, pregnancy tests should be done whenever they have late or missed menses or other signs of possible pregnancy. Women with the potential of becoming pregnant should be tested before starting potentially teratogenic therapies such as efavirenz (EFV). Patients should be alerted on potential teratogenic effects on the fetus, and suitable contraception should be prescribed. 12 Contraceptive methods recommended for women with HIV include condoms, which also protect against STDs and prevent HIV transmission to their partners, and hormonal methods. The drug interactions between oral contraceptives and many drugs used in HIV disease make an additional means of contraception advisable in many cases. Spermicides and intrauterine devices are not recommended for use by HIV-infected women. HIV testing should be a routine part of prenatal care for all women. HIV testing should be voluntary using the “opt out” method (the HIV test is part of routine bloodwork and the woman may opt to refuse the test). Pre- and post-test HIV counseling should be provided. All pregnant women infected with HIV should receive antiretroviral therapy. Zidovudine monotherapy can be provided to untreated pregnant women with a baseline viral load of
A Guide to Primary Care of People with HIV/AIDS Chapter 12: Family Planning and Pregnancy SUGGESTED RESOURCES Al-Kahn A, Colon J, Palta V, Bardeguez A. Assisted reproductive technology for men and women infected with human immunodeficiency virus type1. Clin Infect Dis. 2003;36:195-200. Anderson J. HIV and reproduction. In Anderson J, ed. A Guide to the Clinical Care of Women with HIV. Rockville MD: Health Resources and Services Administration, 2001:212-221. Available at http://www.hab.hrsa.gov. Bartlett J. Recommendations for antiretroviral therapy in pregnancy. 2003 Medical Management of HIV Infection. Baltimore MD: Johns Hopkins University School of Medicine. 2003:96-105. Available at http://www.hopkins-aids.edu/. Pham P, Barditch-Crovo P. Pharmacologic Considerations in HIV-Infected Pregnant Patients. In Anderson J, ed. A Guide to the Clinical Care of Women with HIV. Available at http://www.hab.hrsa.gov. Public Health Service Task Force. Guidelines for the Use of Antiretroviral Agents in HIV- Infected Adults and Adolescents. Available at http://www.aidsinfo.nih.gov. Public Health Service Task Force. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission in the United States. Available at http:// www.aidsinfo.nih.gov. Wang C, Celum C. Prevention of HIV. In Anderson J, ed. A Guide to the Clinical Care of Women with HIV. Available at http: //www.hab.hrsa.gov. World Health Organization. (2001) Global Strategy for Infant and Young Child Feeding. Document A54/7. REFERENCES American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care. 5th Ed. Elkgrove, IL: American Academy of Pediatrics; 2002. American College of Obstetricians and Gynecologists. Ethics in Obstetrics and Gynecology, 2nd Ed. Washington, DC: American College of Obstetricians and Gynecologists; 2004. Available at http://www.acog.org/from%5Fhome/ publications/ethics Accessed 2/04. American College of Obstetricians and Gynecologists. Human immunodeficiency virus screening. Joint statement of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. Pediatrics. 1999;104:128. American College of Obstetricians and Gynecologists. Technical Bulletin Number 205: Preconceptional Care. Washington, DC: American College of Obstetricians and Gynecologists; 1995. Centers for Disease Control and Prevention. Advancing HIV Prevention: New Strategies for a Changing Epidemic – United States, 2003. MMWR. 2003;52:329-332. Centers for Disease Control and Prevention. Revised Recommendations for HIV Screening of Pregnant Women. MMWR. 2001;50(RR19):59-86. Available at http: //www.cdc.gov/mmwr/PDF/rr/rr5019.pdf. Accessed 1/04. Centers for Disease Control and Prevention. Recommendations of the U.S. Public Health Service Task Force on the Use of Zidovudine to Reduce Perinatal Transmission of Human Immunodeficiency Virus. MMWR. 1995;43(RR11):1-20. Cooper ER, Charurat M, Mofenson L, et al. Combination antiretroviral strategies for the treatment of pregnant HIV-1-infected women and prevention of perinatal HIV-1 transmission. J Acquir Immune Defic Syndr. 2002;29:484-494. 12 U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau 103
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