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Prophylaxis and treatment of HIV-1 infection in pregnancy: Swedish recommendations 2013

Naver, Lars; Albert, Jan; Bottiger, Ylva; Carlander, Christina; Flamholc, Leo LU ; Gisslen, Magnus; Josephson, Filip; Karlstrom, Olof; Lindborg, Lena and Svedhem-Johansson, Veronica, et al. (2014) In Scandinavian Journal of Infectious Diseases 46(6). p.401-411
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... (More)
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. (Less)
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publication status
published
subject
keywords
HIV, pregnancy, mother-to-child transmission, prophylaxis, mode of, delivery, follow-up
in
Scandinavian Journal of Infectious Diseases
volume
46
issue
6
pages
401 - 411
publisher
Informa Healthcare
external identifiers
  • wos:000336454800001
  • scopus:84900854600
ISSN
1651-1980
DOI
10.3109/00365548.2014.898333
language
English
LU publication?
yes
id
02692dea-6479-4a93-b1a1-7512d0307db1 (old id 4559043)
date added to LUP
2014-08-01 07:42:01
date last changed
2017-10-22 04:09:01
@article{02692dea-6479-4a93-b1a1-7512d0307db1,
  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 &gt; 34 gestational weeks and HIV RNA is &lt; 50 copies/ml and no obstetric contraindications exist; (5) if HIV RNA is &lt; 50 copies/ml and delivery is at &gt; 34 gestational weeks, intravenous zidovudine is not recommended regardless of the delivery mode; (6) if HIV RNA is &gt; 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 &lt; 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.},
  author       = {Naver, Lars and Albert, Jan and Bottiger, Ylva and Carlander, Christina and Flamholc, Leo and Gisslen, Magnus and Josephson, Filip and Karlstrom, Olof and Lindborg, Lena and Svedhem-Johansson, Veronica and Svennerholm, Bo and Sonnerborg, Anders and Yilmaz, Aylin and Pettersson, Karin},
  issn         = {1651-1980},
  keyword      = {HIV,pregnancy,mother-to-child transmission,prophylaxis,mode of,delivery,follow-up},
  language     = {eng},
  number       = {6},
  pages        = {401--411},
  publisher    = {Informa Healthcare},
  series       = {Scandinavian Journal of Infectious Diseases},
  title        = {Prophylaxis and treatment of HIV-1 infection in pregnancy: Swedish recommendations 2013},
  url          = {http://dx.doi.org/10.3109/00365548.2014.898333},
  volume       = {46},
  year         = {2014},
}