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D. Heather Watts, Lynne M. Mofenson, Antiretrovirals in Pregnancy: A Note of Caution, The Journal of Infectious Diseases, Volume 206, Issue 11, 1 December 2012, Pages 1639–1641, https://doi.org/10.1093/infdis/jis581
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(See the Major Article by Chen et al, on pages 1695–705.)
Maternal-to-child transmission (MTCT) of human immunodeficiency virus (HIV) has been reduced to <1% in resource-rich settings with universal HIV testing of pregnant women, antenatal highly active antiretroviral therapy (HAART) for all women regardless of maternal CD4+ cell count, scheduled cesarean delivery for women without viral suppression near delivery, and avoidance of breast-feeding [1, 2]. The World Health Organization (WHO) recently issued guidance for resource-limited settings that emphasized the programmatic and operational advantages of using a single universal HAART regimen both to treat HIV-infected women and to prevent MTCT in women who do not require treatment for their own health; these guidelines discuss the potential benefits from initiating life-long HAART in all pregnant women (called Option B+) [3]. The 2010 WHO guidelines recommended HAART for treatment of all women with CD4+ cell counts ≤350 cells/mm3 or WHO stage 3 or 4 disease, and a choice of 2 effective regimens to reduce MTCT in women with CD4+ cell counts >350 cells/mm3 not yet requiring therapy: antenatal zidovudine (ZDV) with single-dose nevirapine (NVP) and 1-week ZDV–lamivudine (3TC) tail with daily infant NVP during breast-feeding (Option A) or a maternal triple-drug HAART regimen during pregnancy and breast-feeding (Option B) [4]. Available data in women with higher CD4+ cell counts suggest similar in utero transmission rates for antepartum ZDV compared with HAART, as well as similar postpartum transmission rates for daily infant NVP compared with maternal HAART [5, 6]. Although the use of a single HAART regimen in all pregnant women is programmatically appealing, more data are needed regarding the potential benefits and risks of the 2 strategies for women not yet requiring therapy for their own health.
