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Maternal therapy for HIV in pregnancy.

Therapy for the HIV-infected woman during pregnancy is directed at both maximizing maternal health and reducing the risk of perinatal transmission. The benefits of therapy in improving maternal health, minimizing viral replication to prevent resistance, and decreasing the risk of vertical transmission must be balanced against the potential toxicity, teratogenicity, and uncertain long-term effects. Because the use of zidovudine during pregnancy did not become widespread until the reporting of the Pediatric AIDS Clinical Trials Group (PACTG) protocol 076 results in 1994, and because protease inhibitors have only recently become available, the long-term effects of antiretroviral therapy during pregnancy on the child are unknown. Based on current data, the benefits of therapy for preservation of the health of the mother and prevention of transmission of HIV to the fetus and infant outweigh the risks known thus far or postulated, based on laboratory and animal studies. However, long-term follow-up of all infants and children exposed to antiretrovirals during pregnancy or the neonatal period is crucial. Specific considerations and concerns regarding antiretroviral therapy in pregnancy are outlined in this chapter.