U.S.
Panel Releases Updated Pregnancy and Perinatal HIV Treatment Guidelines
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| SUMMARY:
On May 24, the U.S. Department of Health and Human Services
(DHHS) released the latest
revision of federal treatment guidelines for pregnant
women with HIV. Antiretroviral therapy during pregnancy
is intended both to benefit the woman's health and to
prevent transmission of HIV to the baby. The update
does not include major changes to prior recommendations,
but features a new rating system (similar to the adult
guidelines) and adds further information about drug
resistance, treatment of HIV/HBV
coinfected pregnant women, safe delivery methods,
and the potential for infant cardiac toxicity with ritonavir-boosted
protease inhibitors (PIs). |
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By
Liz Highleyman
Below
is the text of an announcement from the DHHS AIDSInfo service
summarizing the changes.
The
complete pregnancy and perinatal guidelines are available online
at www.aidsinfo.nih.gov/ContentFiles/PerinatalGL.pdf.
Updated
Perinatal Treatment Guidelines Now Available
AIDSinfo
announces the release of the updated 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.
Key
issues and new information discussed in the guidelines include:
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Introduction
of rating of recommendations based on strength of recommendation
and quality of evidence. |
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Update
on recent international clinical trials, including trials
of prevention of postnatal transmission and drug resistance
in infants infected despite infant or maternal antiretroviral
prophylaxis of postnatal infection. |
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New
discussion of the categories and the criteria used for recommendations
about use of specific drugs or drug regimens in pregnancy. |
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Additional
discussion of options for antiretroviral prophylaxis when
an HIV/HBV coinfected
pregnant woman does not require antiretroviral therapy for
her own health or treatment for hepatitis
B disease. |
|
Discussion
of stopping NNRTI-based regimens and strategies to reduce
the risk of resistance, including short-term continuation
of a NRTI component or switching to a PI prior to discontinuing
therapy. |
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Updated
information on combination antiretroviral drug use and pregnancy
outcome and nevirapine hepatic toxicity in pregnancy. |
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New
information regarding resistance following discontinuation
of triple drug prophylaxis after delivery and new information
from clinical trials on response to therapy following single-dose
nevirapine exposure. |
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New
references on use of dual NRTI "tail" to reduce
risk of nevirapine
[Viramune] resistance. |
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Reorganization
and update of Mode of Delivery section. |
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Caution
on use of lopinavir-ritonavir
[Kaletra] (and other boosted PIs) in newborns, particularly
preterm infants, due to reports of cardiac toxicity (heart
block). |
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Discussion
of new data on feeding infants premasticated food and risk
of HIV transmission. |
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Contact
information for the National Perinatal HIV Hotline.
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New
information is highlighted in yellow throughout the text and in
tables.
The
updated guidelines and a separate PDF file of all tables can be
downloaded from the Perinatal Guidelines section of AIDSinfo.
You may also go to the AIDSinfo Order Publications page to request
the guidelines via e-mail.
Your
Feedback Is Important
The
HHS Panel on Treatment of HIV-Infected Pregnant Women and Prevention
of Perinatal Transmission welcomes feedback on the latest revisions
to the 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. Please
send your comments with the subject line "Perinatal Comments"
to ContactUs@aidsinfo.nih.gov by June 7, 2010.
5/28/10
Reference
Panel
on Treatment of HIV-Infected Pregnant Women and Prevention of
Perinatal Transmission. 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. May 24, 2010.
Other
source
U.S.
DHHS. Updated Perinatal Treatment Guidelines Now Available AIDSinfo
At-a-Glance 21. May 24, 2010.
