Although zidovudine (ZDV) chemoprophylaxis alone has substantially reduced the risk for perinatal transmission, antiretroviral monotherapy is now considered suboptimal for treatment of HIV infection and combination drug regimens are considered the standard of care for therapy both for treatment of HIV infection and for prevention of perinatal HIV transmission.
scheduled cesarean delivery for HIV infected pregnant women with HIV RNA levels >1,000
copies/mL near the time of delivery.
Antiretroviral drugs reduce perinatal transmission by several mechanisms,
including lowering maternal antepartum viral load, and pre- and post-exposure
prophylaxis of the infant. Therefore, for prevention of perinatal HIV transmission,
combined antepartum, intrapartum, and infant antiretroviral prophylaxis is
recommended.
Longer duration of antepartum antiretroviral prophylaxis (e.g., starting at 28 weeks
gestation) is more effective than shorter duration (e.g., starting at 36 weeks
gestation); therefore, for women who do not require immediate initiation of
therapy for their own health, prophylaxis should be started by 28 weeks gestation
If women do not receive antepartum antiretroviral drugs, intrapartum combined
with infant antiretroviral prophylaxis should be given to reduce the risk of perinatal
transmission ,although this is not as effective as when antepartum therapy is also given.
If women do not receive antepartum or intrapartum antiretroviral drugs, postnatal
infant antiretroviral prophylaxis is recommended with a minimum of 6 weeks
of ZDV
In the United States, the addition of single-dose intrapartum/newborn NVP
to the standard antepartum combination antiretroviral regimens used for prophylaxis
or treatment in pregnant women is not recommended because it does not appear
to provide additional efficacy in reducing transmission and may be associated with
the development of NVP resistance.
More prolonged post-exposure prophylaxis of the infant does not appear to substitute for
longer duration of maternal therapy