There is no doubt that antiretroviral therapy is clearly beneficial for pregnant women. The risk of transmission to the baby is significantly reduced as ALL women pregnant should be treated with drugs that have action against human immunodeficiency virus.
However, today no treatment completely eliminates this risk and there is no way to diagnose the baby before birth. In addition, an unknown effect that many of the drugs used for AIDS may have on the developing fetus. Therefore, when making decisions about what to do should take into account the risk-benefit for the child and mother, taking into account the medicines you have taken the mother previously and if there is experience with drugs.
The only drug approved for use during pregnancy is the zidovudine (AZT) . This is given to the mother orally throughout pregnancy, intravenously during delivery and the newborn droplets during their first six weeks of life. The largest study done so far with this drug administered in three ways got decrease transmission by 25% to 8% without adversely affecting the development of children.
You have investigated other strategies, such as giving nevirapine to the mother during childbirth and infant in the early hours of life. The advantage is that it is cheap and can be used in developing countries. Can also be used in women who have been treated during pregnancy by not consulting or have discovered that they were HIV positive at the end of gestation. In cases where the mother is not treated during pregnancy or childbirth, the baby should be given right after birth, which will reduce the chance of infection.
Combining several drugs
The combination of drugs is far more effective to control HIV infection treatment with a single drug. This is true in all patients, and it should also be pregnant. Any doubts that may arise when taking a single drug (AZT or nevirapine) or more are based on the lack of studies to see if the combinations are harmful to the fetus.
Early use of combination therapy were reported some complications, preterm delivery rate or cerebral hemorrhage. The combination AZT, 3TC and indinavir appeared to be more frequently involved in these problems, but it is unclear to what extent drugs were responsible for complications or there were other factors.
Later, with the exception of efavirenz (Sustiva), no birth defects have been identified that can be attributed to the use of drugs against HIV in humans or animals. In animal studies, efavirenz caused severe brain damage , so its use should be avoided during pregnancy.
As hyperbilirubinemia (the increase in the blood of bilirubin, a pigment produced in the liver) of pregnant women may harm the developing fetus, it is advisable to monitor patients taking protease inhibitors , since these drugs may increase the bilirubin in the blood.
As summary we can say that you can not give any absolute guarantee pregnant women, so the decision should be made individually. is important that the doctor and the mother decided to form consesuada .
WHEN TO START?
In the first quarter , the risk of infection is relatively low and the chances of producing drugs are major problems. Therefore, if There is no medical emergency (eg an infection difficult to control if not increase the defenses of the mother) can be beneficial to delay the start until week 12-14 of pregnancy. If the pregnant woman wants to start treatment immediately to reduce the risk of infection should not be denied this option.
When the woman learns she is HIV positive after the first trimester is advisable to begin treatment immediately . Even in later stages of pregnancy (Allas of the week 36), the therapy has proved useful, reducing the risk of infection to the child
. WHAT IF ALREADY TAKING ANTIRETROVIRAL?
With pregnant women are already taking an anti-HIV therapy is to decide whether to continue or discontinue treatment during the first quarter . Therapy was discontinued at this stage to allow normal development of the baby's organs, and can cause the mother mpeoramiento with increased viral load, which can lead to an increased risk of infection. Keep it could increase the likelihood of occurrence malformations .
Usually most experts agree that if the mother's situation is stable should maintain the treatment throughout pregnancy . When the mother does not want for fear of the possible effects on the fetus can make a 'therapeutic holidays' during the first quarter. In case of withdrawal of treatment should be discontinued all medications at once, and when reitroduzcan start all at the same time.
Sometimes the withdrawal of treatment in the first quarter arises for other reasons: the morning sickness. Some pregnant women vomit often in the morning and do not tolerate medication or are unsure of compliance siel being adequate for the vomiting. In such cases, a complete suspension best treatment to take it the wrong way, which could increase the risk of the virus becoming resistant and spreading to the child.
In this case there is a high risk and can assess the baby treatment with AZT and 3TC, as little is known doses of both drugs in the neonatal period. Another option would be the treatment with nevirapine , given the excellent results he has had in some studies. Can study the possibility of adding a dose of this drug in the first hours of life and a second at 72 hours, a measure that is able to maintain the drug concentration for a week. In the postpartum assess the status of the mother and the need to initiate treatment. Some authors recommend combination treatment for the newborn, especially if the mother virus resistant to treatment
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