Prophylactic Cesarean Delivery for the Prevention of Perinatal Human Immunodeficiency Virus Transmission

Stringer, Jeffrey S. A.; Rouse, Dwight J.; Goldenberg, Robert L.

doi:10.1001/jama.281.20.1946

Cited by 43 publications

(21 citation statements)

References 41 publications

(31 reference statements)

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“…20,21 For nonbreastfeeding pregnant women with HIV infection, successful combination therapy with 3 ARV drugs and resultant reduction of maternal plasma virus load to below the limits of detection on sensitive assays (the goal of standard ARV therapy) is associated with rates of MTCT of HIV of less than 1%. [22][23][24] Current US Public Health Service (USPHS) guidelines for prevention of MTCT of HIV recommend use of combination ARV regimens including at least 3 ARV drugs during pregnancy and labor for all pregnant women with HIV infection. ARV drugs are discontinued after delivery unless the mother requires ARV therapy for her own health, in which case ARV therapy would be continued following guidelines for nonpregnant HIV-infected adults.…”

Section: Benefits Of Hiv Testing Early In Pregnancymentioning

confidence: 99%

HIV Testing and Prophylaxis to Prevent Mother-to-Child Transmission in the United States

2008

Pediatrics

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Universal HIV testing of pregnant women in the United States is the key to prevention of mother-to-child transmission of HIV. Repeat testing in the third trimester and rapid HIV testing at labor and delivery are additional strategies to further reduce the rate of perinatal HIV transmission. Prevention of mother-to-child transmission of HIV is most effective when antiretroviral drugs are received by the mother during her pregnancy and continued through delivery and then administered to the infant after birth. Antiretroviral drugs are effective in reducing the risk of mother-to-child transmission of HIV even when prophylaxis is started for the infant soon after birth. New rapid testing methods allow identification of HIV-infected women or HIV-exposed infants in 20 to 60 minutes. The American Academy of Pediatrics recommends documented, routine HIV testing for all pregnant women in the United States after notifying the patient that testing will be performed, unless the patient declines HIV testing (“opt-out” consent or “right of refusal”). For women in labor with undocumented HIV-infection status during the current pregnancy, immediate maternal HIV testing with opt-out consent, using a rapid HIV antibody test, is recommended. Positive HIV antibody screening test results should be confirmed with immunofluorescent antibody or Western blot assay. For women with a positive rapid HIV antibody test result, antiretroviral prophylaxis should be administered promptly to the mother and newborn infant on the basis of the positive result of the rapid antibody test without waiting for results of confirmatory HIV testing. If the confirmatory test result is negative, then prophylaxis should be discontinued. For a newborn infant whose mother's HIV serostatus is unknown, the health care professional should perform rapid HIV antibody testing on the mother or on the newborn infant, with results reported to the health care professional no later than 12 hours after the infant's birth. If the rapid HIV antibody test result is positive, antiretroviral prophylaxis should be instituted as soon as possible after birth but certainly by 12 hours after delivery, pending completion of confirmatory HIV testing. The mother should be counseled not to breastfeed the infant. Assistance with immediate initiation of hand and pump expression to stimulate milk production should be offered to the mother, given the possibility that the confirmatory test result may be negative. If the confirmatory test result is negative, then prophylaxis should be stopped and breastfeeding may be initiated. If the confirmatory test result is positive, infants should receive antiretroviral prophylaxis for 6 weeks after birth, and the mother should not breastfeed the infant.

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Section: Benefits Of Hiv Testing Early In Pregnancymentioning

confidence: 99%

HIV Testing and Prophylaxis to Prevent Mother-to-Child Transmission in the United States

2008

Pediatrics

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“…-Elective CS before labor and before rupture of membranes associated with a two-thirds reduction in MTCT risk • Highly active antiretroviral therapy (HAART) era: uncertainty regarding the additional benefit of elective CS in women with low or undetectable plasma viral loads receiving HAART [52,203,121] Postpartum complications…”

Section: Effectiveness Of Elective Cesarean Section (Cs) In Reducing mentioning

confidence: 99%

Managing Mother-to-Child Transmission of HIV Infection in Developed-Country Settings

Thorne¹,

Newell²

2005

Womens Health (Lond Engl)

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This article reviews current understanding of the management of mother-to-child transmission of HIV-1 infection in the context of developed-country settings. The advent of highly active antiretroviral therapy has facilitated the virtual elimination of mother-tochild transmission of HIV infection in developed countries, reducing transmission rates to approximately 1-2%. This review describes the epidemiology of HIV infection among women of child-bearing age and the risk factors, timing and mechanisms of mother-tochild transmission, followed by a discussion of the identification of pregnant HIV-infected women and their therapeutic and obstetric management.This review will focus on the management of mother-to-child transmission (MTCT) of HIV-1 in developed-country settings. However, the vast majority of pediatric HIV infections acquired from mother to child take place in developingcountry settings, mainly in sub-Saharan Africa, which is home to 60% of people living with HIV infection worldwide. The World Health Organization (WHO) has published extensive guidelines on the use of antiretroviral drugs for treating pregnant women and preventing MTCT in resource-constrained settings [1] and on infant feeding, together with the United Nations International Children's Emergency Fund (UNICEF) and the United Nations Programme on HIV/AIDS (UNAIDS) [2]. Although evidence from clinical trials and studies in developing countries have identified effective interventions for prevention of MTCT in such settings, implementation of these and expansion of prevention of MTCT services remains a substantial challenge [3][4][5][6], as does prevention of HIV infection in women of childbearing age (Box 1).

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“…For example, there are reasonable data that performing a Cesarean section prior to the onset of labor will reduce maternal-infant transmission by about 50-80% in women not receiving antiviral therapy 45,46 . Since most pregnant women in many developed countries receive combination antiviral therapy and have low viral loads, the relevance of this observation to most HIVpositive women in those countries is not clear, and Cesarean sections are not performed routinely in most locations 47 . However, in order to reduce fetal exposure to the virus, recommendations exist to expedite delivery once membranes have ruptured, to use a minimum number of interventions and to avoid infant lacerations or contact with maternal blood 43 .…”

Section: Perinatal Hiv Transmission In Developed Countriesmentioning

confidence: 99%

Perinatal HIV transmission: developing country considerations

Goldenberg

Stringer

Sinkala

et al. 2002

The Journal of Maternal-Fetal & Neonatal Medicine

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In many developing countries, because the prevalence of maternal HIV infection is high (more than 30% in some sub-Saharan African countries) and the resources commonly used to prevent transmission in developed countries are generally not available, transmission of HIV from mother to infant is a devastating problem. Countries already experiencing infant mortality rates 10- to 20-fold greater than those in developed countries can expect a doubling of infant and childhood mortality due to HIV. Those infants who escape infection themselves can expect to be orphaned in early childhood. Low-cost antiviral therapy can reduce transmission substantially, but many countries do not have the infrastructure to screen pregnant women for HIV and appropriately treat the mothers and infants. In developing countries, reduction in maternal-child transmission is feasible, but will require substantial additional resources and a well-functioning obstetric care system.

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Prophylactic Cesarean Delivery for the Prevention of Perinatal Human Immunodeficiency Virus Transmission

Cited by 43 publications

References 41 publications

HIV Testing and Prophylaxis to Prevent Mother-to-Child Transmission in the United States

HIV Testing and Prophylaxis to Prevent Mother-to-Child Transmission in the United States

Managing Mother-to-Child Transmission of HIV Infection in Developed-Country Settings

Perinatal HIV transmission: developing country considerations

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