Canadian HIV Pregnancy Planning Guidelines
Canadian HIV Pregnancy Planning Guidelines
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DOI：
10.1016/j.ijgo.2012.06.004
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发表时间：
2012-10-01
影响因子：
3.8
通讯作者：
Yudin, Mark H.
中科院分区：
文献类型：
--
作者：
Loutfy, Mona R.;Margolese, Shari;Yudin, Mark H.
目的：艾滋病毒阳性个人和夫妇在怀孕计划和咨询方面需要考虑四个主要临床问题：(1)孕前健康；(2)母婴传播，通过联合抗逆转录病毒治疗已显著减少；(3)怀孕期间伴侣之间的传播，这需要根据参与者的状况和需求采取不同的预防和治疗策略；以及(4)不孕不育问题的管理。《加拿大艾滋病毒怀孕计划指南》的目的是为保健提供者提供临床信息和建议，以协助艾滋病毒阳性个人和夫妇作出生育和怀孕计划决定。这些指导方针是以证据和社区为基础和灵活的，它们考虑到各种和交叉的地方/人口需求和健康的社会决定因素。成果：预期成果是：(1)减少艾滋病毒垂直传播和水平传播的风险，(2)在艾滋病毒存在的情况下改善孕产妇和婴儿的健康结果，(3)减少与怀孕和艾滋病毒有关的耻辱，以及(4)增加获得怀孕规划和生育服务的机会。证据：应用计算机检索PubMed和Medline2010年12月20日之前发表的英文或法文文章，检索词为：“HIV”、“怀孕”、“妊娠计划”、“生育”、“生殖”、“不孕”、“父母身份”、“人工授精”、“人工授精”、“精子清洗”、“IVF”、“ICSI”或“IUI”。其他搜索词还包括“HIV”、“水平传播”、“性传播”或“不一致的血清”。还检索了下列会议数据库：逆转录病毒和机会性感染会议、国际艾滋病会议、国际艾滋病学会、关于抗菌剂和化疗的科学间会议、加拿大艾滋病毒/艾滋病研究协会和安大略省艾滋病毒治疗网络研究会议。最后，对关键期刊和会议进行手工搜索，并审查检索到的文章的参考文献以寻找更多的引文。随后，根据摘要的主要主题(根据指南的大纲)将摘要分类为表格形式，其标题如下：作者、标题、研究目的、参与者、结果和一般性评论。最后，征求了该领域专家的意见，以确定是否遗漏了任何文章。价值：根据加拿大预防保健工作组报告中描述的标准对证据质量进行评级。根据该报告(表)中描述的方法并通过使用用于制定临床指南的指南研究和评估工具来对实践建议进行排名。赞助商：加拿大妇产科医生协会、妇女和艾滋病毒研究计划、女子学院研究所、女子学院医院、多伦多大学、雅培实验室、加拿大安大略省艾滋病毒治疗网络、加拿大卫生研究所和加拿大艾滋病毒试验网络。
Objective: Four main clinical issues need to be considered for HIV-positive individuals and couples with respect to pregnancy planning and counselling: (1) pre-conceptional health; (2) transmission from mother to infant, which has been significantly reduced by combined antiretroviral therapy; (3) transmission between partners during conception, which requires different prevention and treatment strategies depending on the status and needs of those involved; and (4) management of infertility issues. The objective of the Canadian HIV Pregnancy Planning Guidelines is to provide clinical information and recommendations for health care providers to assist HIV-positive individuals and couples with their fertility and pregnancy planning decisions. These guidelines are evidence- and community-based and flexible, and they take into account diverse and intersecting local/population needs and the social determinants of health. Outcomes: Intended outcomes are (1) reduction of risk of vertical transmission and horizontal transmission of HIV, (2) improvement of maternal and infant health outcomes in the presence of HIV, (3) reduction of the stigma associated with pregnancy and HIV, and (4) increased access to pregnancy planning and fertility services. Evidence: PubMed and Medline were searched for articles published in English or French to December 20, 2010, using the following terms: "HIV" and "pregnancy" or "pregnancy planning" or "fertility" or "reproduction" or "infertility" or "parenthood" or "insemination" or "artificial insemination" or "sperm washing" or "IVF" or "ICSI" or "IUI." Other search terms included "HIV" and "horizontal transmission" or "sexual transmission" or "serodiscordant." The following conference databases were also searched: Conference on Retroviruses and Opportunistic Infections, International AIDS Conference, International AIDS Society, Interscience Conference on Antimicrobial Agents and Chemotherapy, the Canadian Association of HIV/AIDS Research, and the Ontario HIV Treatment Network Research Conference. Finally, a hand search of key journals and conferences was performed, and references of retrieved articles were reviewed for additional citations. Subsequently, abstracts were categorized according to their primary topic (based on an outline of the guidelines) into table format with the Following headings: author, title, study purpose, participants, results and general comments. Finally, experts in the field were consulted for their opinions as to whether any articles were missed. Values: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice were ranked according to the method described in that report (Table) and through use of the Appraisal of Guidelines Research and Evaluation instrument for the development of clinical guidelines. Sponsors: The Society of Obstetricians and Gynecologists of Canada, Women and HIV Research Program, Women's College Research Institute, Women's College Hospital, University of Toronto, Abbott Laboratories Canada, the Ontario HIV Treatment Network, the Canadian Institutes of Health Research, and the Canadian HIV Trials Network.