British HIV Association guidelines for the management of HIV infection in pregnant women 2012 (2014 interim review)
British HIV Association guidelines for the management of HIV infection in pregnant women 2012 (2014 interim review)
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DOI：
10.1111/hiv.12185
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发表时间：
2014-09-01
期刊：
影响因子：
3
通讯作者：
Wilkins, Ed
中科院分区：
文献类型：
--
作者：
de Ruiter, Annemiek;Taylor, Graham P.;Wilkins, Ed
管理艾滋病毒阳性患者的主要成功之一是预防艾滋病毒-1的母婴传播（MTCT）。随着HIV-1的常规产前筛查的广泛实施，HIV-1从母亲传染给孩子现在在英国已经很少见了。尽管最近很少有关于在妊娠或产科干预中使用抗逆转录病毒治疗（ART）的随机对照试验，但实践仍在不断发展。这在很大程度上取决于观测数据、理论考虑和专家意见。一开始，编写小组的目的是使这些指南尽可能具有临床相关性和实用性。写作小组起草了一份反映日常实践和疑问的问题清单。会议承认，其中许多专题的证据水平很差，但认识到有必要提供指导。这些准则已扩展到与艾滋病毒阳性孕妇临床护理有关的所有领域。该指南旨在告知和帮助保健工作者管理感染艾滋病毒的孕妇。这些建议并不是规定性的或限制性的，人们认识到，在最佳管理可能偏离这些建议的情况下，将会出现新的数据，以便更好地为实践提供信息。产科管理是一个特别的重点。越来越多的妇女希望通过阴道分娩，但紧急剖腹产的比例有所增加。希望这些准则中所载的建议能够进一步提高阴道分娩的比例，减少紧急剖腹产的数量。与此相关的是建议在怀孕期间暂时接受抗逆转录病毒联合治疗（cART）的妇女开始妊娠，这一建议已根据基线病毒载量提前提出。预计这将导致更大比例的妇女在妊娠36周时达到< 50 HIV RNA拷贝/mL的病毒载量，从而使她们能够计划阴道分娩。
One of the major successes in the management of HIV-positive patients has been the prevention of mother-tochild transmission (MTCT) of HIV-1. With the widespread implementation of routine antenatal screening for HIV-1, transmission of HIV-1 from mother to child is now a rare occurrence in the UK. Despite few recent randomized controlled trials regarding the use of antiretroviral therapy (ART) in pregnancy or obstetric intervention, practice continues to evolve. This is largely informed by observational data, theoretical considerations and expert opinion. At the outset, the aim of the Writing Group was to make these guidelines as clinically relevant and as practical as possible. The Writing Group drew up a list of questions reflecting day-to-day practice and queries. It was acknowledged that the level of evidence for many of these topics was poor but recognized that there was a need to provide guidance. These guidelines have expanded on all areas relevant to the clinical care of HIV-positive pregnant women. The guidelines are intended to inform and aid healthcare workers in the management of pregnant women with HIV. They are not intended to be prescriptive or restrictive and it is recognized that situations will arise where the optimum management may deviate from these recommendations and new data will emerge to better inform practice.A particular focus has been obstetric management. An increasing number of women are aiming for and achieving a vaginal delivery but the rate of emergency Caesarean sections has increased. It is hoped that the recommendations contained within these guidelines will enable a further increase in the proportion of vaginal deliveries and a reduction in the number of emergency Caesarean sections. Linked to this is the proposed starting gestation for women temporarily taking combination antiretroviral therapy (cART) in pregnancy, which has been brought forward depending on baseline viral load. It is anticipated that this will result in a larger proportion of women achieving a viral load of< 50 HIV RNA copies/mL by 36 weeks’ gestation, thereby allowing them to plan for a vaginal delivery.