Management of HIV infection during pregnancy

Optimal management of HIV infection in pregnancy requires maternal use of p otent antiretroviral therapy to prevent disease progression in the mother a nd vertical transmission to the newborn, Combination antiretroviral therapy substantially reduces the risk of perinatal HIV transmission and appears t o be more effective than zidovudine monotherapy, The administration of sing le dose nevirapine to mother intrapartum and infant postpartum effectively reduces vertical HIV transmission and is less costly and cumbersome than zi dovudine regimens. Elective cesarean section reduces vertical transmission of HIV but its benefit is less clear when antiretroviral therapy decreases maternal plasma HIV viral load to low levels at delivery, If possible, HIV- infected mothers should avoid breastfeeding, The present review discusses t he importance of early identification of maternal HIV infection, strict adh erence to combination antiretroviral regimens to prevent drug resistance, d eveloping a better understanding of antiretroviral pharmacokinetics in preg nancy and short/long term safety of anti-HIV drugs. (C) 2000 Lippincott Wil liams & Wilkins.