ARV and Adherence

Preventing transmission of HIV from mother to baby during pregnancy and delivery is the primary objective of the HIV team. Here Dr Say Quah gives an overview of the management of HIV during pregnancy.....

 

Basics of ARV therapy and importance of adherence

  • Treatment for HIV in pregnancy is based on two considerations:
    • The woman’s own health
    • Reducing the risk of MTCT
  • Clinical factors influencing ARV therapy:
    • Immune status (CD4 count)
    • Virological status (Viral load)
    • Genotypic resistance
    • Gestational age at presentation
    • Potential risk of therapy to the pregnancy
    • Preferred mode of delivery
  • It takes time for ARV regimes to work. For the majority of cases presenting early, complete suppression should be achievable by 12-14 weeks after initiation of ARVs 
  • Late presenters (>28 weeks) commence HAART without delay and may require intensified treatment
  • All pregnant women are recommended to start on treatment and remain on it lifelong. Women should commence ART as soon as they are able to do so in the second trimester, or within the first trimester if their VL>100,000 copies /ml or CD4 cell count is less than 200 cells/mm. All women should have commenced ART by week 24 of pregnancy.
  • When prescribing any other medications, consider drug interactions with antiretroviral drugs 
  • There can be potential overlapping of adverse side effects of ARV and complications of pregnancy e.g. cholestasis, pre-eclampsia and other signs of liver dysfunction
  • Although drug regimes are managed and prescribed by the HIV team, support relating to education and adherence may be required from other health care professionals. Strict adherence to ARV therapy is vital to prevent the development of resistance which could impact on future choices of effective drug regimes

 

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