The Use of Antiretroviral Medication in HIV Positive Pregnant Woman

Introduction

Pregnant women with HIV infection should regularly receive clinical, virology, and immunologic evaluation of the virus. This is important in determining the viral load as well as the effectiveness of the medications in order to make a decision whether to continue with the drugs or change the regime (Lowdermilk, Perry, & Cashion, 2013). There is a need to counsel them on the use of the medications to ensure compliance that is very important in HIV treatment. The use of at least three drugs is essential to prevent prenatal transmission of HIV to the infant. ARV use is the successful method in reducing plasma HIV RNA to lower levels, reducing the chances of prenatal transmission (Hirsch et al., 2000). Thus, mother to child transmission is important in the reduction of HIV transmission.

The overall rate of the mother to child transmission between the year 2000 and 2006 was 1.2 percent in 5000 HIV infected mothers. Observation on the transmission rate has reduced to 0.8 percent with the use of ARV drugs, regardless of the regime used in the treatment, especially in the last 14 days of pregnancy. In addition, good antenatal care and care during delivery, reduced transmission rates have reduced dramatically (Ricci & Kyle, 2009).

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Important Points

  1. All the HIV positive mothers should use a potent combination of antiretroviral medication regime to reduce the risk of prenatal transmission to the infants.
  2. The choice of the regime should take into account current treatment guidelines as well as the possible risks associated with the medication of the mother and child.
  3. The decision as to whether to start a regime in the first 12 weeks of gestation depends on the CD4 T-lymphocyte count as well as on the mother’s health status.
  4. The combination of an ARV regime should include nucleoside reverse transcriptase inhibitor due to its high level of the transplacental passage, thus very effective ARV in a regime in the reduction of mother to child transmissions.
  5. ARV drug resistance studies are important before starting treatment to ensure the effectiveness of the drugs prescribed.
  6. If a mother is tested with HIV infection later during pregnancy, an ARV regimen is initiated promptly with the results of resistance being tested.

Historical Background of ARV Therapy

HIV virus discovery was in 1981 attributed to homosexual men. HAART therapy among pregnant women began with the discovery of Zidovudine in 1986 as the first drug to reduce the HIV virus in the body. Following later clinical trials, a number of nucleosides were introduced in the market and dual and triple regimes were introduced. An estimated 33 million people are suffering from the HIV virus worldwide with 1.1 of the infections attributed to maternal infections during birth or during the antenatal period. Every year about 56000 new infections occur each year. With the discovery of antiretroviral medication, HIV cases are now manageable (Ioannidis et al., 2001).

Excess of mother to child transmissions among the pregnant women to their infants has been halved especially in the HAART era. Today it is possible for an HIV positive mother to deliver an HIV negative baby. This became possible with proper management of positive mothers during pregnancy together with the use of antiretroviral drugs during the antenatal period (De Cock et al., 2000).

Mother to Child Transmission of HIV

Mother to child transmission of HIV refers to the spread of HIV from a pregnant woman to her child during pregnancy or at the time of birth. The child can also contact the HIV virus from breast milk or any infected fluid shared by the mother and the child. Mother to child transmission is the most common way that a child contracts the HIV virus from its mother. Antiretroviral drugs function in various ways in the reduction of HIV transmission from the mother to the child. They help in decreasing the chances of HIV transmission to the baby during pregnancy and at childbirth.

Some of the used HIV antiretroviral medications have the ability to cross from the mother to the baby across the placenta and are very effective in preventing mother to child transmission of the virus. The transmission of HIV chances increases closer to the delivery date when the child is exposed to the mother’s blood and other body fluids (Ricci & Kyle, 2009).

AIDS-related deaths among women and children have greatly decreased over recent years. This is because of the proper management of pregnant women during pregnancy as well as good use of HIV medications. Most of the HIV positive women are between the ages of 14-44 years; therefore, it is very important to understand the interaction between HIV, family planning, and the use of antiretroviral medications. Pregnancy decision making is difficult to make for an HIV positive woman (Hammer et al., 2008).

They have to deal with the signs and symptoms of HIV and prevent the mother to child transmission of the disease. This becomes more difficult to cope with, especially in cases of poverty, stigma, drug, and substance abuse. However, there are a few differences found between the reproductive beliefs, behaviors, and attitudes of an HIV negative and positive mother (Tuomala et al., 2002).

 

The Safety of the Antiretroviral Medications Use During Pregnancy

During pregnancy, HIV, positive mothers can safely use HIV medications. Some of the medications are teratogenic to the fetus and have the ability to pass through the placenta. It is necessary to use the correct combination of drugs as well as the right dosage (De Cock et al., 2000). However, health care providers have to consider the side effects associated with certain medications during pregnancy, related body changes that are associated with the medication that can affect pregnancy and the potential short and long-term effects that are associated with the drugs to the baby and the mother. It is important to consider the benefits as well as the risks associated with prescribing a given regime to the patient (Hirsch et al., 2000).

The use of highly active antiretroviral therapy (HAART) in combination with the appropriate labor management reduces the rate of HIV transmission dramatically. The rate reduced to less than 1 percent, thus highly active. Little evidence is available on the teratogenic effects associated with the use of ARV medication. A drug like Efavirenz in large doses during pregnancy is associated with congenital defects such as spinal Bifida and Dandy-walker syndrome. It is very important to consider the combination and dosage to prevent such effects (Ioannidis et al., 2001).

Research conducted shows a correlation between HAART treatment, pre-term delivery, and small for gestation age infants. However, little is yet to be proved on such accusations and all HIV positive mothers are being encouraged on the need and importance of using ARV medications. Confounding factors during pregnancy that could be a cause of the concerns raised above include drug abuse during pregnancy, socioeconomic status, obstetric history, or pre-existing illness of the mother. Thus, the use of anti-HIV drugs during pregnancy is more beneficial than harmful (Lowdermilk et al., 2013).

Ethical, Legal, and Political Considerations Related to ARVs Use

Pregnant mothers infected with HIV virus face a number of legal and ethical issues. Controversies have raised over the access of drugs and the regulatory approval pathways of the ARV drugs over the past years. This has led to delays in the delivery of drugs, making the control of mother to child transmission a challenge. Stigmatization of the mothers suffering from the virus is a major issue affecting them and children, though their acceptance has greatly improved recently. HIV patients are often economically, politically, and socially vulnerable in the community (Ricci & Kyle, 2009).

HIV is linked with socially sensitive behavior in the community, thus creating tension and fear among the infected. Some of the HIV medications are very expensive to buy, thus, deplete mothers economically. The care and treatment of pregnant women are limited by clinical evidence trials to support treatment choices. Some of the treatment choices used provide little information on the risks and advantages of the combinations used. Therefore, it is important for further research and clinical trials to provide evidence for the use of antiretroviral drugs (Lowdermilk et al., 2013).

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Conclusion

Antiretroviral therapy use during pregnancy focuses on reducing prenatal transmission of the virus from the mother to the baby as well as reducing the treatment of the maternal human immunodeficiency virus. ARV therapies have the ability to reduce mother to child transmission of HIV virus, i.e. lowering the maternal antepartum viral load and act as pre-exposure and post-exposure prophylaxis to the baby (Lowdermilk et al., 2013). The risk of HIV transmission from a mother to a child has greatly declined due to the use of antiretroviral medications.

Another contribution attributed to the declined mother to child transmission includes universal testing of all mothers to rule out any infection and proper management of labor with appropriate use of cesarean section and the avoidance of breastfeeding by HIV positive mothers. The choice of the regime to use should take into current treatment guidelines consideration as well as the possible risks associated with the medication of mother and child. The benefits should be greater than the risks involved. If a mother discovers that she has HIV later in pregnancy, an ARV regimen has to be started promptly without even the results of resistance testing.

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