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DHHS Updates Perinatal Antiretroviral Treatment Guidelines

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The Department of Health and Human Services has once again updated its Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States.

Key changes are described in the What’s New in the Guidelines section, and revisions are highlighted in yellow throughout the document.

Key Updates:

  • Updated findings and lessons learned from international clinical trials of antiretroviral drugs to reduce perinatal transmission of HIV, including data from HPTN 046 on extended nevirapine during breastfeeding and NICHD-HPTN 040/PACTG 1043 showing benefits of combination antiretroviral therapy for formula-fed infants.
  • New Preconception Care section featuring discussion of reproductive options for HIV concordant (same status) and serodiscordant (different status) couples, including data from HPTN 052 showing that early treatment prevents transmission.
  • Updated table on interactions between hormonal contraceptives and antiretroviral drugs.
  • Addition of drug formulation and dosing information to table on use of antiretroviral drugs during pregnancy.
  • Modified recommendations for use of tenofovir (Viread, also in the Truvada and Atripla coformulations) during pregnancy, upgrading it to an alternate drug, or preferred for women with HIV/hepatitis B virus (HBV) coinfection.
  • New recommendations on antiretroviral regimens for pregnant women with HIV/HBV coinfection.
  • Indinavir (Crixivan) and nelfinavir (Viramune) moved from Alternative protease inhibitor choices to PIs to Use in Special Circumstances.
  • New section on diagnosis and management of acute HIV-1 infection during pregnancy.
  • New section on management of HIV-2 during pregnancy.
  • Data from recent studies on outcomes including preterm delivery among women taking combination antiretroviral regimens during pregnancy.
  • Updated Postpartum Care section with expanded discussion of antiretroviral drug discontinuation after giving birth.
  • Updated recommendations on antiretroviral prophylaxis for infants whose mothers did not receive antiretroviral drugs prior to delivery.
  • New information on dosing of prophylactic antiretroviral drugs for HIV-exposed newborns.
  • New section on management of breastfeeding infants of mothers first diagnosed with HIV during the postpartum period.

The new guidelines are available in HTML and PDF formats, as well as a mobile version for smartphones.

The HHS Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission welcomes feedback on the updated guidelines. Comments may be sent to JLIB_HTML_CLOAKING by September 30, 2011.

9/16/11

Reference

DHHS.Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal HealthandInterventions to Reduce Perinatal HIV Transmission in the United States (http://www.aidsinfo.nih.gov/Guidelines/GuidelineDetail.aspx?GuidelineID=9&ClassID=2). Updated September 14, 2011.

Other Source

AIDSInfo. Updated HHS Perinatal Antiretroviral Treatment Guidelines Now Available in PDF and HTML Formats. September 14, 2011.