Prophylaxis and treatment of HIV-1 infection in pregnancy: Swedish recommendations 2013

Abstract

Prophylaxis and treatment with antiretroviral drugs and elective caesarean section delivery have resulted in very low mother-to-child transmission of HIV during recent years. Updated general treatment guidelines and increasing knowledge about mother-to-child transmission have necessitated regular revisions of the recommendations for the prophylaxis and treatment of HIV-1 infection in pregnancy. The Swedish Reference Group for Antiviral Therapy (RAV) updated the recommendations from 2010 at an expert meeting on 11 September 2013. The most important revisions are the following: (1) ongoing efficient treatment at confirmed pregnancy may, with a few exceptions, be continued; (2) if treatment is initiated during pregnancy, the recommended first-line therapy is essentially the same as for non-pregnant women; (3) raltegravir may be added to achieve rapid reduction in HIV RNA; (4) vaginal delivery is recommended if at > 34 gestational weeks and HIV RNA is < 50 copies/ml and no obstetric contraindications exist; (5) if HIV RNA is < 50 copies/ml and delivery is at > 34 gestational weeks, intravenous zidovudine is not recommended regardless of the delivery mode; (6) if HIV RNA is > 50 copies/ml close to delivery, it is recommended that the mother should undergo a planned caesarean section, intravenous zidovudine, and oral nevirapine, and the infant should receive single-dose nevirapine at 48-72 h of age and post-exposure prophylaxis with 2 drugs; (7) if delivery is preterm at < 34 gestational weeks, a caesarean section delivery should if possible be performed, with intravenous zidovudine and oral nevirapine given to the mother, and single-dose nevirapine given to the infant at 48-72 h of age, as well as post-exposure prophylaxis with 2 additional drugs.

Longitudinal trends and determinants of patient-reported side effects on ART–a Swedish national registry study

“…The introduction of new antiretroviral agents probably contributed to this decrease since we found a correlation between the drop in reported side effects and alterations in the prescribed third agent in ART during the time period. The changes in ART prescription, recommended by the Swedish HIV treatment guidelines [18][19][20] and also presented in a previous study [23], were characterized by the decline in prescription of EFV and PI and the increased prescription of integrase inhibitors as third agents.…”

“…Fifteen of these also provided data through individual qualitative interviews. During the data collection period, PLWH received ART according to the Swedish HIV treatment guidelines; these were updated in 2009 [18], 2013 [19] and 2016 [20].…”

Cabergoline: a review of its use in the inhibition of lactation for women living with HIV

“…While as early as 1998, De Ruiter suggested that WLWH “may benefit from the administration of bromocriptine or cabergoline” , there is no discussion of lactation inhibition in the US , the Australian or the World Health Organization guidelines . The 2014 and the 2017 Swedish guidelines suggest that “The woman should be provided support to interrupt the milk production” but no specific measure is suggested . The 2008 British guidelines suggested for the first time the use of cabergoline .…”

Vaginal delivery in women with HIV in Italy: results of 5 years of implementation of the national SIGO-HIV protocol

“…The main eligibility criterion was represented by undetectable HIV-RNA plasma viral load (< 50 copies/ml in 2012). This approach is common to most national guidelines from European countries, while other European (France, Sweden, Denmark and Holland) and non-European countries (Canada, US) have selected a less stringent approach, considering eligible for vaginal delivery also women with low-level detectable HIV-RNA (usually no more than 150-1000 copies/ml, according to the individual national guidelines) [2][3][4][5][14][15][16][17][18][19].…”