All women with HIV need antiretroviral treatment during pregnancy, regardless of CD4 count. All HIV-exposed neonates must receive zidovudine (at minimum) for 6 weeks postpartum. The treatment of pregnant women with HIV does not differ from that of non-pregnant women, mainly multi-therapy antiretroviral combination.
Mother-to-child transmission (MTCT) of HIV is very preventable with adequate treatment of both mother and baby. Treating the mother with Highly Active Anti-Retroviral Therapy (HAART) during pregnancy and the neonate for 6 weeks after birth reduces risk of HIV transmission by 70%. The current recommendation is to put women on HAART (generally, two NRTIs and one NNRTI) as HIV quickly becomes resistant to monotherapy. Another measure to reduce transmission is avoidance of breastfeeding, if formula feeding is safe (i.e. - clean water supply) and feasible.
Fogler et al. examine delivery options for pregnant women with HIV. They argue that the decision to delivery via c-section or vaginally is a complex one that must be decided on a case by case basis. Particularly important factors are viral load and whether labor has started.
Taylor and Buttenheim discuss concepts from behavioral economics that could be applied to help optimize prevention of MTCT(PMTCT). The five concepts are mentoring, economic incentives, default bias, and loss aversion. Although PMTCT efforts in the United States have been quite successful (Illustration A), they has not been 100% effective. Globally, they face even more obstacles.
Illustration A is a graph that depicts the number of perinatally-acquired HIV cases per year from 1985-2005 in the United States.
Answer 1: It is never safe to give no treatment when a pregnant woman is HIV-positive, as she has a 1 in 4 chance of passing the virus to the neonate during pregnancy, labor, or delivery.
Answer 2: Although treatment decisions for other HIV-positive groups are sometimes based on CD4 count, in pregnant women, the WHO and CDC recommend all receive ARVs, regardless of CD4 count.
Answer 3: Giving ARVS during labor and delivery is not as effective at PMTCT as giving them throughout pregnancy.
Answer 5: Although treating the mother with ARVs during pregnancy does reduce risk of MTCT, postnatal treatment of the neonate is necessary to minimize risk of MTCT.
Fogler J, Cohan D, Weber S, Goldschmidt RH. Delivery options for prevention of perinatal HIV transmission. Am Fam Physician. 2009 Dec 15;80(12):1356.
PMID:20000297 (Link to Abstract)
Taylor NK, Buttenheim AM. Improving utilization of and retention in PMTCT services: Can behavioral economics help? BMC Health Serv Res. 2013 Oct 10;13:406. doi: 10.1186/1472-6963-13-406.
PMID:24112440 (Link to Abstract)