The efficacy and tolerability of combination antiretroviral therapy in pregnancy: infant and maternal outcome

Antiretroviral therapy (ART) and Caesarean section (CS) delivery significan tly reduce the risk of vertically transmitted HIV infection. Attention must focus on determining the optimal management strategy for HIV-positive preg nancies. Guidelines must reflect not only the activity and tolerability of combination ART in pregnancy for mother and infant and the potential short and long-term infant toxicity, but also whether surgical delivery can confe r an added benefit if combination ART had reduced plasma viraemia to undete ctable levels. To aid the development of management strategies for the Republic of Ireland , a retrospective detailed review of all HIV-positive pregnancies since the introduction of combination ART was undertaken. Since 1997 there have been 25 deliveries to 24 woman. Combination ART reduc ed plasma viraemia to undetectable levels in 76% mothers at delivery. The C S rate was 28% and no unanticipated infant toxicity was encountered To date no infant has proven infected. Three infants have seroreverted and 24 of 2 6 infants have had at least 2 negative HIV ribonucleic acid (RNA) and polym erase chain reaction (PCR) tests. Two infants are less than one month old. in this study, the CS rate of 28% is below that reported from many centres yet no vertical transmission was found. Given the efficacy of ART in reduci ng plasma viraemia, the additional benefit of CS for these women is questio nable.