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Treatment of HIV in Pregnancy: What Are the Risks?


(AUDIO) Antiviral drugs have reduced intrauterine transmission of HIV dramatically. But what are the effects on the pregnancy itself? Here an infectious diseases expert discusses the risks and the benefits.

The HAART regimen and other antivirals can all but eliminate the risk that the HIV virus will be transmitted to a fetus during pregnancy. But what are the risks to the pregnancy itself from the use of these medications?

The answer isn't entirely clear, and some studies suggest there can be adverse effects.

Here to put the risks and benefits in perspective for the physicians who treat HIV-infected women is a brief recorded conversation wth Kathleen Squires MD, a professor of in the Division of Infectious Diseases at Thomas Jefferson University Hospitals in Philadephia.

The questions:

1. There have been some studies that raise some questions about the safety of some of the therapies that are used today to prevent HIV transmission during pregnancy. I was hoping you could help put the risks and benefits in perspective for us.

2. How would you sum up the message for clinicians who are going to be caring for pregnant women?

Featured quotations:

"There was a study performed in the '90s that showed that for mothers who received ... monotherapy, the risk of transmission for those babies was reduced from 25% to 8%... In areas where Moms have access to antiretroviral therapy, we are seeing transmission rates that are 1% or below, so clearly a very large benefit.".

"Some of the antiretroviral agents that we have are associated with risks during pregnancy ...
There have been a number of studies that have suggested that we see an increased risk of early labor (with protease inhibitors). We don't really understand ... the basis for that risk."

"Unfortunately, for many of the antiretroviral agents we have very little data about the use of those agents during pregnancy."

Treatment of HIV in Pregnancy: What Are the Risks?

REFERENCES:  Recommendations for use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and interventions to reduce perinatal HIV transmission in the United States.
Centers for Disease Control and Prevention, 1998, updated 2012

British HIV Association guidelines for the management of HIV infection in pregnant women 2012HIV Medicine, September 2012

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