HIV and pregnancy: how to manage conflicting recommendations from evidence-based guidelines

Research output: Contribution to journalLetterOther

Abstract

In resource rich settings transmission of HIV from mother to child during pregnancy and post partum has been significantly reduced by access to interventions such as maternal and neonatal antiretroviral therapy, avoidance of breast feeding and consideration to caesarean section. Accumulating observational and randomised controlled studies provide the evidence for development of guidelines for the clinical management of these women. However, despite referencing the same studies, differences exist between recommendations originating from the United States versus the United Kingdom. The particular areas of controversy include use of efavirenz, dose adjustment of antiretrovirals during pregnancy, mode of delivery according to maternal viral load, duration of neonatal zidovudine, use of PJP prophylaxis and number of antiretrovirals to prescribe in a neonate considered high risk of acquiring HIV infection. This article summarises these differences and suggests ways of approaching and adapting these conflicting recommendations to the local setting. ? 2013 Wolters Kluwer Health Lippincott Williams Wilkins.
Original languageEnglish
Pages (from-to)857 - 862
Number of pages6
JournalAIDS
Volume27
Issue number6
DOIs
Publication statusPublished - 2013

Cite this

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title = "HIV and pregnancy: how to manage conflicting recommendations from evidence-based guidelines",
abstract = "In resource rich settings transmission of HIV from mother to child during pregnancy and post partum has been significantly reduced by access to interventions such as maternal and neonatal antiretroviral therapy, avoidance of breast feeding and consideration to caesarean section. Accumulating observational and randomised controlled studies provide the evidence for development of guidelines for the clinical management of these women. However, despite referencing the same studies, differences exist between recommendations originating from the United States versus the United Kingdom. The particular areas of controversy include use of efavirenz, dose adjustment of antiretrovirals during pregnancy, mode of delivery according to maternal viral load, duration of neonatal zidovudine, use of PJP prophylaxis and number of antiretrovirals to prescribe in a neonate considered high risk of acquiring HIV infection. This article summarises these differences and suggests ways of approaching and adapting these conflicting recommendations to the local setting. ? 2013 Wolters Kluwer Health Lippincott Williams Wilkins.",
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HIV and pregnancy: how to manage conflicting recommendations from evidence-based guidelines. / Giles, Michelle Leanne.

In: AIDS, Vol. 27, No. 6, 2013, p. 857 - 862.

Research output: Contribution to journalLetterOther

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T1 - HIV and pregnancy: how to manage conflicting recommendations from evidence-based guidelines

AU - Giles, Michelle Leanne

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AB - In resource rich settings transmission of HIV from mother to child during pregnancy and post partum has been significantly reduced by access to interventions such as maternal and neonatal antiretroviral therapy, avoidance of breast feeding and consideration to caesarean section. Accumulating observational and randomised controlled studies provide the evidence for development of guidelines for the clinical management of these women. However, despite referencing the same studies, differences exist between recommendations originating from the United States versus the United Kingdom. The particular areas of controversy include use of efavirenz, dose adjustment of antiretrovirals during pregnancy, mode of delivery according to maternal viral load, duration of neonatal zidovudine, use of PJP prophylaxis and number of antiretrovirals to prescribe in a neonate considered high risk of acquiring HIV infection. This article summarises these differences and suggests ways of approaching and adapting these conflicting recommendations to the local setting. ? 2013 Wolters Kluwer Health Lippincott Williams Wilkins.

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