ART = antiretroviral therapy; NRTI = nucleoside reverse transcriptase inhibitor; ROM = rupture of membranes; ZDV = zidovudine. Adapted from the Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission, 2016. Department of Health and Human Services.
healthy woman with HIV has no signiicant efect on disease Vertical transmission is increased by breastfeeding, and it genprogression (Calvert, 2015). Linkage to general HIV care posterally is not recommended for HIV-positive women in the partum is critical to maintain viral suppression (Swain, 2016). United States, where formula is readily available (Read, 2003). For women who do not have HIV infection, but whose In nutritionally deprived countries, where infectious disease partner is seropositive, current guidance supports the use of and malnutrition are primary causes of infant death, the World highly active antiretroviral therapy with viral suppression in the Health Organization (2016) recommends exclusive breastfeeding infected partner (treatment as prevention), and consideration during the first 6 to 12 months. of antiretroviral preexposure prophylaxis (PreP) for the HIV he Panel on Treatment of HI V-Infected Pregnant Women negative partner. The well-counseled couple can consider periand Prevention of Perinatal Transmission (2016) strongly recovulatory condomless intercourse, or uterine insemination or ommends that ART regimens not be discontinued postpartum in vitro fertilization after sperm washing for assisted conception but continued lifelong for the advantages of viral suppression. (Brooks, 2017; Kawwass, 2017). Ideally, all those planning pregnancy should be receiving ART If, instead, pregnancy is undesired, efective contraception is and have a plasma viral load below detectable levels before discussed (Chap. 38, p. 680). Counseling also includes education conception. As one benefit, interpregnancy viral load suppresfor decreasing high-risk sexual behaviors to prevent transmission sion is associated with less vertical transmission in a subsequent and to decrease other STD acquisition. Similarly, women with pregnancy (French, 2014; Mandelbrot, 2015; Stewart, 2014; HIV have unique gynecological issues, such as genital neoplasia, Townsend, 2014). Reassuringly, for those seeking subsequent which require special attention (American College of Obstetripregnancy, when ART is available, repeated pregnancy in a cians and Gynecologists, 2016a; Werner, 2016).
Alexander ]M, Sheield ]S, Sanchez P], et al: Eicacy of treatment for syphilis in pregnancy. Obstet Gynecol 93:5, 1999
Alger LS, Lovchik]C, Hebel ]R, et al: The association of Chlamydia trachomatis, Neisseria gonorrhoeae, and group B streptococci with preterm rupture of the membranes and pregnancy outcome. Am] Obstet Gynecol 159:397, 1988
Allsworth ]E, Peipert ]F: Prevalence of bacterial vaginosis: 2001-2004 National Health and Nutrition Examination Survey data. Obstet Gynecol 109(1):114,t200
Allsworth ]E, Ratner ]A, Peipert ]F: Trichomoniasis and other sexually transmitted infections: results from the 2001-2004 National Health and Nutrition Examination Surveys. Sex Transm Dis 38,t2009