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Chapter 25 - Human Immunodeficiency Virus in Pregnancy (Content last reviewed: 23rd July 2019)

Published online by Cambridge University Press:  15 November 2017

David James
University of Nottingham
Philip Steer
Imperial College London
Carl Weiner
University of Kansas
Bernard Gonik
Wayne State University, Detroit
Stephen Robson
University of Newcastle
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The management of human immunodeficiency virus (HIV) infection continues to evolve rapidly. Amazing advances have been made in therapy of primary infection, prevention of opportunistic infections, and prevention of perinatal transmission since the first cases of acquired immune deficiency syndrome (AIDS) were described in 1981. Perinatal transmission rates have decreased from 20–30% early in the epidemic to < 1% in high-income countries with the use of antiretroviral therapy and scheduled cesarean delivery.

High-Risk Pregnancy
Management Options
, pp. 621 - 643
Publisher: Cambridge University Press
First published in: 2017

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Centers for Disease Control and Prevention (CDC). HIV among pregnant women, infants, and children. Updated 2016. (accessed March 2017).
World Health Organization (WHO). Number of women living with HIV. (accessed March 2017).
Whitmore, SK, Zhang, X, Taylor, AW, Blair, JM. Estimated number of infants born to HIV-infected women in the United States and five dependent areas, 2006. J Acquir Immune Defic Syndr 2011; 57: 218–22. doi: 10.1097/QAI.0b013e3182167dec.
Nesheim, SR, Wiener, J, Fitz Harris, LF, Lampe, MA, Weidle, PJ. Brief report: estimated incidence of perinatally acquired HIV infection in the United States, 1978–2013. J Acquir Immune Defic Syndr 2017; 76: 461–4. doi: 10.1097/QAI.0000000000001552.
UNAIDS. UNAIDS Report on the Global AIDS Epidemic 2013. Joint United Nations Programme on HIV/AIDS (UNAIDS), 2013, pp. 38–9. (accessed March 2017).
DeCock, KM, Fowler, MG, Mercier, E, et al. Prevention of mother-to-child HIV transmission in resource-poor countries: translating research into policy and practice. JAMA 2000; 283: 1175–82.
Centers for Disease Control and Prevention (CDC). Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health care settings. MMWR Morb Mortal Wkly Rep 2006; 55 (RR-14): 117.
Centers for Disease Control and Prevention (CDC). Laboratory testing for the diagnosis of HIV infection: updated recommendations. (accessed March 2017).
Centers for Disease Control and Prevention (CDC). Success in implementing Public Health Service guidelines to reduce perinatal transmission of HIV-Louisiana, Michigan, New Jersey, and South Carolina, 1993, 1995, and 1996. MMWR Morb Mortal Wkly Rep 1998; 47: 688–91.
Nielsen-Saines, K, Watts, DH, Veloso, VG, et al. Three postpartum antiretroviral regimens to prevent intrapartum HIV infection. N Engl J Med 2012; 366: 2368–79.
Wade, NA, Birkhead, GS, Warren, BL, et al. Abbreviated regimens of zidovudine prophylaxis and perinatal transmission of the human immunodeficiency virus. N Engl J Med 1998; 339: 1409–14.
Petra Study Team. Efficacy of three short-course regimens of zidovudine and lamivudine in preventing early and late transmission of HIV-1 from mother to child in Tanzania, South Africa, and Uganda (Petra study): A randomised double-blind placebo-controlled trial. Lancet 2002; 359: 1178–86.
Moodley, D, Moodley, J, Coovadia, H, et al.; South African Intrapartum Nevirapine Trial (SAINT) Investigators. A multicenter randomized controlled trial of nevirapine versus a combination of zidovudine and lamivudine to reduce intrapartum and early postpartum mother-to-child transmission of human immunodeficiency virus type 1. J Infect Dis 2003; 187: 725–35.
American College of Obstetrics and Gynecology. ACOG Committee Opinion No. 418: Prenatal and perinatal human immunodeficiency virus testing: expanded recommendations. Obstet Gynecol 2008; 112: 739–42.
Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. 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. (accessed March 2017).
Saada, M, Le Chenadec, J, Berrebi, A, et al. Pregnancy and progression to AIDS: Results of the French prospective cohorts. AIDS 2000; 14: 2355–60.
Burns, DN, Landesman, S, Minkoff, H, et al. The influence of pregnancy on human immunodeficiency virus type 1 infection: antepartum and postpartum changes in human immunodeficiency virus type 1 viral load. Am J Obstet Gynecol 1998; 178: 355–9.
Weisser, M, Rudin, C, Battegay, M, et al. Does pregnancy influence the course of HIV infection? Evidence from two large Swiss cohort studies. J Acquir Immune Defic Syndr Hum Retrovirol 1998; 15: 404–10.
Minkoff, H, Hershow, R, Watts, DH, et al. The relationship of pregnancy to HIV disease progression. Am J Obstet Gynecol 2003; 189: 552–9.
Deschamps, MM, Pape, JW, Desvarieux, M, et al. A prospective study of HIV-seropositive asymptomatic women of childbearing age in a developing country. J Acquir Immune Defic Syndr 1993; 6: 446–51.
Kumar, RM, Uduman, SA, Khurrana, AK. Impact of pregnancy on maternal AIDS. J Reprod Med 1993; 42: 429–34.
Calvert, C, Ronsmans, C. Pregnancy and HIV disease progression: a systematic review and meta-analysis. Trop Med Int Health 2015; 20: 122–45.
Bristol-Myers Squibb. Dear healthcare provider letter, January 5, 2001. (accessed March 2017).
Hill, JB, Sheffield, JS, Zeeman, GG, Wendel, GD. Hepatotoxicity with antiretroviral treatment of pregnant women. Obstet Gynecol 2001; 98: 909–11.
Ibdah, JA, Yang, Z, Bennett, MJ. Liver disease in pregnancy and fetal fatty acid oxidation defects. Mol Genet Metab 2000; 71: 182–9.
Grimbert, S, Fromenty, B, Fisch, C, et al. Decreased mitochondrial oxidation of fatty acids in pregnant mice: possible relevance to development of acute fatty liver of pregnancy. Hepatology 1993; 17: 628–37.
Grimbert, S, Fisch, C, Deschamps, D, et al. Effects of female sex hormones on mitochondria: possible role in acute fatty liver of pregnancy. Am J Physiol 1995; 268: G107–15.
Brinkman, K, ter Hofstede, HJM, Burger, DM, et al. Adverse effects of reverse transcriptase inhibitors: mitochondrial toxicity as common pathway. AIDS 1998; 12: 1735–44.
Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. (accessed March 2017).
Bardeguez, AD, Shapiro, DE, Mofenson, LM, et al. Effect of cessation of zidovudine prophylaxis to reduce vertical transmission on maternal HIV disease progression and survival. J Acquir Immune Defic Syndr 2003; 32: 170–81.
Watts, DH, Lambert, J, Stiehm, ER, et al.; PACTG 185 Study Team. Progression of HIV disease among women following delivery. J Acquir Immune Defic Syndr 2003; 33: 585–93.
Strategies for Management of Antiretroviral Therapy (SMART) Study Group. CD4+ count-guided interruption of antiretroviral treatment. N Engl J Med 2006; 355: 2283–96.
Brocklehurst, P, French, R. The association between maternal HIV infection and perinatal outcome: a systematic review of the literature and meta-analysis. Br J Obstet Gynaecol 1998; 105: 836–48.
Bucceri, A, Luchini, L, Rancilio, L, et al. Pregnancy outcome among HIV positive and negative intravenous drug users. Eur J Obstet Gynecol Reprod Biol 1997; 72: 169–74.
Ellis, J, Williams, H, Graves, W, Lendsay, MK. Human immunodeficiency virus infection is a risk factor for adverse perinatal outcome. Am J Obstet Gynecol 2002; 186: 903–6.
Leroy, V, Ladner, J, Nyiraziraje, M, et al. Effect of HIV-1 infection on pregnancy outcome in women in Kigali, Rwanda, 1992–1994. AIDS 1998; 12: 643–50.
Stratton, P, Tuomala, RE, Abboud, R, et al. Obstetric and newborn outcomes in a cohort of HIV-infected pregnant women: a report of the Women and Infants Transmission Study. J Acquir Immune Defic Syndr 1999; 20: 179–86.
Lambert, JS, Watts, DH, Mofenson, L, et al.; Pediatric AIDS Clinical Trials Group 185 Team. Risk factors for preterm birth and low birth weight in infants born to HIV-infected pregnant women receiving zidovudine. AIDS 2000; 14: 1389–99.
Sansone, M, Sarno, L, Saccone, G, et al. Risk of preeclampsia in human immunodeficiency virus-infected pregnant women. Obstet Gynecol 2016; 127: 1027–32. doi: 10.1097/AOG.0000000000001424.
Browne, JL, Schrier, VJ, Grobbee, DE, Peters, SA, Klipstein-Grobusch, K. HIV, antiretroviral therapy, and hypertensive disorders in pregnancy: a systematic review and meta-analysis. J Acquir Immune Defic Syndr 2015; 70: 91–8. doi: 10.1097/QAI.0000000000000686.
Sebitloane, HM, Moodley, J. Maternal and obstetric complications among HIV-infected women treated with highly active antiretroviral treatment at a regional hospital in Durban, South Africa. Niger J Clin Pract 2017; 20: 1360–7. doi: 10.4103/njcp.njcp_328_16.
Machado, ES, Krauss, MR, Megazzini, K, et al. Hypertension, preeclampsia and eclampsia among HIV-infected pregnant women from Latin America and Caribbean countries. J Infect 2014; 68: 572–80. doi: 10.1016/j.jinf.2013.12.018.
Suy, A, Martinez, E, Coll, O, et al. Increased risk of pre-eclampsia and fetal death in HIV-infected pregnant women receiving highly active antiretroviral therapy. AIDS 2006; 20: 5966. PMID: 16327320.
Sebitloane, HM, Moodley, J, Sartorius, B. Associations between HIV, highly active anti-retroviral therapy, and hypertensive disorders of pregnancy among maternal deaths in South Africa 2011–2013. Int J Gynaecol Obstet 2017; 136: 195–9. doi: 10.1002/ijgo.12038.
Connor, EM, Sperling, RS, Gelber, R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment: Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J Med 1994; 331: 1173–80.
European Collaborative Study. Is zidovudine therapy in pregnant HIV-infected women associated with gestational age and birth weight? AIDS 1999; 13: 119–24.
Lorenzi, P, Spicher, VM, Laubereau, B, et al. Antiretroviral therapies in pregnancy: maternal, fetal and neonatal effects. Swiss HIV Cohort Study, the Swiss Collaborative HIV and Pregnancy Study, and the Swiss Neonatal HIV Study. AIDS 1998; 12: F241–7.
European Collaborative Study; Swiss Mother and Child HIV Cohort Study. Combination antiretroviral therapy and duration of pregnancy. AIDS 2000; 14: 2913–20.
Tuomala, RE, Shapiro, DE, Mofenson, LM, et al. Antiretroviral therapy during pregnancy and the risk of an adverse outcome. N Engl J Med 2002; 346: 1863–70.
Kourtis, AP, Schmid, CH, Jamieson, DJ, Lau, J. Use of antiretroviral therapy in pregnant HIV-infected women and the risk of premature delivery: a meta-analysis. AIDS 2007; 21: 607–15.
Townsend, CL, Cortina-Borja, M, Peckham, CS, Tookey, PA. Antiretroviral therapy and premature delivery in diagnosed HIV-infected women in the United Kingdom and Ireland. AIDS 2007; 21: 1019–26.
Machado, ES, Hofer, CB, Costa, TT, et al. Pregnancy outcome in HIV-1 infected women receiving combination antiretroviral therapy prior versus after conception. Sex Transm Inf 2009; 85: 82–7.
Schulte, J, Dominguez, K, Sukalac, T, et al.; Pediatric Spetrum of HIV Consortium. Declines in low birth weight and preterm birth among infants who were born to HIV-infected women during an era of increased use of maternal antiretroviral drugs: pediatric spectrum of HIV disease, 1989–2004. Pediatrics 2007; 119: e900–6.
Ravizza, M, Martinelli, P, Bucceri, A, et al.; Italian Group on Surveillance on Antiretroviral Treatment in Pregnancy. Treatment with protease inhibitors and coninfection with hepatitis C virus are independent predictors of preterm delivery in HIV-infected pregnant women. J Infect Dis 2007; 195: 913–34.
Grosch-Woerner, I, Puch, K, Maier, RF, et al.; Multicenter Interdisciplinary Study Group Germany/Austria. Increased rate of prematurity associated with antenatal antiretroviral therapy in a German/Austrian cohort of HIV-1-infected women. HIV Med 2008; 9: 613.
Watts, DH, Williams, PL, Kacanek, D, et al.; Pediatric HIV/AIDS Cohort Study. Combination antiretroviral use and preterm birth. J Infect Dis 2013; 207: 612–21.
Cooper, ER, Charurat, M, Mofenson, L, et al. Combination antiretroviral strategies for the treatment of pregnant HIV-1-infected women and prevention of perinatal HIV-1 transmission. J Acquir Immune Defic Syndr 2002; 29: 484–94.
Minkoff, H. Human immunodeficiency virus infection in pregnancy. Obstet Gynecol 2003; 101: 797810.
Dunn, DT, Newell, ML, Ades, AE, et al. Risk of human immunodeficiency virus type 1 transmission through breastfeeding. Lancet 1992; 340: 585–8.
Mofenson, LM, Lambert, JS, Stiehm, ER, et al. Risk factors for perinatal transmission of human immunodeficiency virus type 1 in women treated with zidovudine. N Engl J Med 1999; 341: 385–93.
Garcia, PM, Kalish, LA, Pitt, J, et al. Maternal levels of plasma human immunodeficiency virus type 1 RNA and the risk of perinatal transmission. N Engl J Med 1999; 341: 394402.
Stiehm, ER, Lambert, JS, Mofenson, L, et al. Efficacy of zidovudine and human immunodeficiency virus (HIV) hyperimmune immunoglobulin for reducing perinatal HIV transmission from HIV-infected women with advanced disease: results of Pediatric AIDS Clinical Trials Group protocol 185. J Infect Dis 1999; 179: 567–75.
Shaffer, N, Chuachoowong, R, Mock, PA, et al. Short-course zidovudine for perinatal HIV-1 transmission in Bangkok, Thailand: a randomized controlled trial. Lancet 1999; 353: 773–80.
Lallemant, M, Jourdain, G, Le Coeur, S, et al. A trial of shortened zidovudine regimens to prevent mother-to-child transmission of human immunodeficiency virus type 1. Perinatal HIV Prevention Trial (Thailand) Investigators. N Engl J Med 2000; 343: 982–91.
Wiktor, SZ, Ekpini, E, Karon, J, et al. Short-course zidovudine for prevention of mother-to-child transmission of HIV-1 in Abidjan, Cote d’Ivoire: a randomised trial. Lancet 1999; 353: 781–5.
Dabis, F, Msellati, P, Meda, N, et al. 6-Month efficacy, tolerance and acceptability of a short regimen of oral zidovudine to reduce vertical transmission of HIV in breastfed children in Cote d’Ivoire and Burkina Faso: a double-blind placebo-controlled multicentre trial. Lancet 1999; 353: 786–92.
DITRAME ANRS 049 Study Group. 15-Month efficacy of maternal oral zidovudine to decrease vertical transmission of HIV-1 in breastfed African children. Lancet 1999; 354: 2050.
Dabis, F, Elenga, N, Meda, N, et al.; DITRAME Study Group. 18-Month mortality and perinatal exposure to zidovudine in West Africa. AIDS 2001; 15: 771–9.
Guay, LA, Musoke, P, Fleming, T, et al. Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother–child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomized trial. Lancet 1999; 354: 795802.
Briand, N, Warszawski, J, Mandelbrot, L, et al. Is intrapartum intravenous zidovudine for prevention of mother-to-child HIV-1 transmission still useful in the combination antiretroviral therapy era? Clin Infect Dis 2013; 57: 903–14.
Cotter, AM, Brookfield, KF, Duthely, LM, et al. Duration of membrane rupture and risk of perinatal transmission of HIV-1 in the era of combination antiretroviral therapy. Am J Obstet Gynecol 2012; 207: 482.e1–5.
Chiappini, E, Galli, L, Giaquinto, C, et al. Use of combination neonatal prophylaxis for the prevention of mother-to-child transmission of HIV infection in European high-risk infants. AIDS 2013; 27: 9911000.
Wong, VV. Is peripartum zidovudine absolutely necessary for patients with a viral load less than 1,000 copies/ml? J Obstet Gynaecol 2011; 31: 740–2.
Dorenbaum, A, Cunningham, CK, Gelber, RD, et al. Two-dose intrapartum/newborn nevirapine and standard antiretroviral therapy to reduce perinatal HIV transmission: a randomized trial. JAMA 2002; 288: 189–98.
Townsend, CL, Cortina-Borja, M, Peckham, CS, et al. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000–2006. AIDS 2008; 22: 973–81.
Forbes, JC, Alimenti, AM, Singer, J, et al.; Canadian Pediatric AIDS Research Group (CPARG). A national review of vertical HIV transmission. AIDS 2012; 26: 757–63.
daCosta, TP, Machado, ES, et al. Malformations among HIV vertically exposed newborns: results from a Brazilian cohort study. Paper presented at the 6th IAS Conference on HIV Pathogenesis and Treatment and Prevention, 2011, Rome, Italy.
Watts, DH, Huang, S, Culnane, M, et al. Birth defects among a cohort of infants born to HIV-infected women on antiretroviral medication. J Perinat Med 2011; 39: 163–70.
Knapp, KM, Brogly, SB, Muenz, DG, et al. Prevalence of congenital anomalies in infants with in utero exposure to antiretrovirals. Pediatr Infect Dis J 2012; 31: 164–70.
Floridia, M, Mastroiacovo, P, Tamburrini, E, et al. Birth defects in a national cohort of pregnant women with HIV infection in Italy, 2001–2011. BJOG 2013; 120: 1466–75.
Sibiude, J, Mandelbrot, L, Blanche, S, et al. Association between prenatal exposure to antiretroviral therapy and birth defects: an analysis of the French perinatal cohort study (ANRS CO1/CO11). PLoS Med 2014; 11: e1001635.
Williams, PL, Crain, MJ, Yildirim, C, et al. Congenital anomalies and in utero antiretroviral exposure in human immunodeficiency virus-exposed uninfected infants. JAMA Pediatr 2015; 169: 4855.
Antiretroviral Pregnancy Registry. Interim Report, 1 January 1989 Through 31 July 2016. (accessed March 2017).
Ford, N, Mofenson, L, Shubber, Z, et al. Safety of efavirenz in the first trimester of pregnancy: an updated systematic review and meta-analysis. AIDS 2014; 28 (Suppl 2): S123–31.
Watts, DH. Teratogenicity risk of antiretroviral therapy in pregnancy. Curr HIV/AIDS Rep 2007; 4: 135–40.
Watts, DH, Li, D, Handelsman, E, et al. Assessment of birth defects according to maternal therapy among infants in WITS. J Acquir Immune Defic Syndr 2007; 44 : 299305.
Brogly, SB, Abzug, MJ, Watts, DH, et al. Birth defects among children born to human immunodeficiency virus-infected women: pediatric AIDS clinical trials protocols 219 and 219C. Pediatr Infect Dis J 2010; 29: 721–7.
Hleyhel, M, Goujon, S, Delteil, C, et al. Risk of cancer in children exposed to didanosine in utero. AIDS 2016; 30: 1245–56. doi: 10.1097/QAD.0000000000001051.
Caniglia, EC, Patel, K, Huo, Y, et al. Atazanavir exposure in utero and neurodevelopment in infants: a comparative safety study. AIDS 2016; 30: 1267–78. doi: 10.1097/QAD.0000000000001052.
Rough, K, Sun, JW, Seage, GR, et al. Zidovudine use in pregnancy and congenital malformations. AIDS 2017; 31: 1733–43. doi: 10.1097/QAD.0000000000001549.
Antiretroviral Pregnancy Registry Steering Committee. Antiretroviral pregnancy registry international interim report for 1 January 1989–31 January 2018. Wilmington, NC: Registry Coordinating Center, 2018. (accessed August 2019).
Drug Safety, FDA Communication: FDA to evaluate potential risk of neural tube birth defects with HIV medicine dolutegravir (Juluca, Tivicay, Triumeq). (accessed September 2018).
Blanche, S, Tardieu, M, Rustin, P, et al. Persistent mitochondrial dysfunction and perinatal exposure to antiretroviral nucleoside analogues. Lancet 1999; 354: 1084–9.
Mandelbrot, L, Landreau-Mascaro, A, Rekacewicz, C, et al. Lamivudine–zidovudine combination for prevention of maternal–infant transmission of HIV-1. JAMA 2001; 285: 2129–31.
Foster, C, Lyall, H. HIV and mitochondrial toxicity in children. J Antimicrob Chemother 2008;61 : 812.
Brogly, SB, Ylitalo, N, Mofenson, LM, et al. In utero nucleoside reverse transcriptase inhibitor exposure and signs of possible mitochondrial dysfunction in HIV-uninfected children. AIDS 2007; 21: 929–38.
Benhammou, V, Tardieu, M, Warszawski, J, Rustin, P, Blanche, S. Clinical mitochondrial dysfunction in uninfected children born to HIV-infected mothers following perinatal exposure to nucleoside analogues. Environ Mol Mutagen 2007; 48: 173–8.
Olivero, OA, Anderson, LM, Diwan, BA, et al. Transplacental effects of 3’-azido-2’3’-dideoxythymidine (AZT): tumorigenicity in mice and genotoxicity in mice and monkeys. J Natl Cancer Inst 1997; 89: 1602–8.
Ayers, KM, Torrey, CE, Reynolds, DJ. A transplacental carcinogenicity bioassay in CD-1 mice with zidovudine. Fundament Appl Toxicol 1997; 38: 195–8.
Hanson, IC, Antonelli, TA, Sperling, RS, et al. Lack of tumors in infants with perinatal HIV-1 exposure and fetal/neonatal exposure to zidovudine. J Acquir Immune Defic Syndr Hum Retrovirol 1999; 20: 463–7.
Brogly, S, Williams, P, Seage, GR, Van Dyke, R. In utero nucleoside reverse transcriptase inhibitor exposure and cancer in HIV-uninfected children: an update from the Pediatric AIDS Clinical Trials Group 219 and 219C cohorts. J Acquir Immune Defic Syndr 2006; 41: 535–6.
Pollock, BH, Jenson, HB, Leach, CT, et al. Risk factors for pediatric human immunodeficiency virus related malignancy. JAMA 2003; 289: 2393–9.
Hankin, C, Lyall, H, Peckham, C, Tookey, PA. Monitoring death and cancer in children born to HIV-infected women in England and Wales: use of HIV surveillance and national routine data. AIDS 2007; 21: 867–77.
Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. (accessed March 2017).
Hirsch, MS, Gunthard, HF, Schapiro, JM, et al. Antiretroviral drug resistance testing in adult HIV-1 infection: 2008 recommendations of an International AIDS Society–USA Panel. Clin Infect Dis 2008; 47: 266–85.
Nolan, M, Fowler, MG, Mofenson, LM. Antiretroviral prophylaxis of perinatal HIV-1 transmission and the potential impact of antiretroviral resistance. J Acquir Immune Defic Syndr 2002; 30: 216–29.
International Perinatal HIV Group. The mode of delivery and the risk of vertical transmission of human immunodeficiency virus type 1: a meta-analysis of 15 prospective cohort studies. N Engl J Med 1999; 340: 977–87.
European Mode of Delivery Collaboration. Elective cesarean section versus vaginal delivery in prevention of vertical HIV-1 transmission: a randomised clinical trial. Lancet 1999; 353: 1035–9.
American College of Obstetricians and Gynecologists. Scheduled Cesarean Delivery and the Prevention of Vertical Transmission of HIV Infection. Washington, DC: ACOG, Number 234, 2000, reaffirmed 2015. (accessed March 2017).
Marcollet, A, Goffinet, F, Firtion, G, et al. Differences in postpartum morbidity in women who are infected with the human immunodeficiency virus after elective cesarean delivery, emergency cesarean delivery, or vaginal delivery. Am J Obstet Gynecol 2002; 186: 784–9.
Madar, J, Richmond, S, Hey, E. Surfactant-deficient respiratory distress after elective delivery at “term”. Acta Paediatr 1999; 88: 1244–8.
Dube, MP. Disorders of glucose metabolism in patients infected with human immunodeficiency virus. Clin Infect Dis 2000; 31: 1467–75.
Hitti, J, Andersen, J, McComsey, G, et al. Protease inhibitor-based therapy does not affect glucose tolerance in pregnancy: AIDS Clinical Trials Group 5084. Am J Obstet Gynecol 2007; 196: 331.e1–7.
Tang, JH, Sheffield, JS, Grimes, J, et al. Effect of protease inhibitor therapy on glucose intolerance in pregnancy. Obstet Gynecol 2006; 107: 1115–19.
Mandelbrot, L, Mayaux, MJ, Bongain, A, et al. Obstetric factors and mother-to-infant transmission of human immunodeficiency virus type 1: the French perinatal cohorts. SEROGEST French Pediatric HIV Infection Study Group. Am J Obstet Gynecol 1996; 175: 661–7.
Tess, BH, Rodrigues, LC, Newell, ML, et al. Breastfeeding, genetic, obstetric and other risk factors associated with mother-to-child transmission of HIV-1 in Sao Paulo State, Brazil. Sao Paulo Collaborative Study for Vertical Transmission of HIV-1. AIDS 1998; 26: 513–20.
Gross, S, Castillo, W, Crane, M, et al. Maternal serum alpha-fetoprotein and human chorionic gonadotropin levels in women with human immunodeficiency virus. Am J Obstet Gynecol 2003; 188: 1052–6.
LeMeaux, JP, Tsatsaris, V, Schmitz, T, et al. Maternal biochemical serum screening for Down syndrome in pregnancy with human immunodeficiency virus infection. Obstet Gynecol 2008; 112: 223–30.
Brossard, P, Boulvain, M, Coll, O, et al. Is screening for fetal anomalies reliable in HIV-infected pregnant women? A multicentre study. AIDS 2008; 22: 2013–17.
Peters, H, Francis, K, Harding, K, Tookey, PA, Thorne, C. Operative vaginal delivery and invasive procedures in pregnancy among women living with HIV. Eur J Obstet Gynecol Reprod Biol 2017; 210: 295–9. doi: 10.1016/j.ejogrb.2016.12.016.
Peters, H, Byrne, L, De Ruiter, A, et al. Duration of ruptured membranes and mother-to-child HIV transmission: a prospective population-based surveillance study. BJOG 2016; 123: 975–81. doi: 10.1111/1471-0528.13442.
Landesman, SH, Kalish, LA, Burns, DN, et al. Obstetrical factors and the transmission of human immunodeficiency virus type 1 from mother to child. N Engl J Med 1996; 334: 1617–23.
International Perinatal HIV Group. Duration of ruptured membranes and vertical transmission of HIV-1: a meta-analysis from 15 prospective cohort studies. AIDS 2001; 15: 357–68.
Alvarez, JR, Bardeguez, A, Iffy, L, Apuzzio, JJ. Preterm premature rupture of membranes in pregnancies complicated by human immunodeficiency virus infection: a single center’s five-year experience. J Matern Fetal Neonatal Med 2007; 20: 853–7.
Gaur, AH, Dominguez, KL, Kalish, ML, et al. Practice of feeding premasticated food to infants: a potential risk factor for HIV transmission. Pediatrics 2009; 124: 658–66. doi: 10.1542/peds.2008-3614.
Majeed, SR, West, SK, Jiang, S, et al. Confirmation of the drug–drug interaction (DDI) potential between cobicistat-boosted antiretroviral regimens and hormonal contraceptives. 18th International Workshop on Clinical Pharmacology of Antiviral Therapy; Chicago, IL, 2017.
Perry, SH, Swamy, P, Preidis, GA, et al. Implementing the Jadelle implant for women living with HIV in a resource-limited setting in sub-Saharan Africa: concerns for drug interactions leading to unintended pregnancies. AIDS 2014; 28: 791–3. PubMed PMID: 24401645.
Scarsi, KK, Darin, KM, Nakalema, S, et al. Unintended pregnancies observed with combined use of the levonorgestrel contraceptive implant and efavirenz-based antiretroviral therapy: a three-arm pharmacokinetic evaluation over 48 weeks. Clin Infect Dis 2016; 62: 675–82. PubMed PMID: 26646680.
Pyra, M, Heffron, R, Mugo, NR, et al. Effectiveness of hormonal contraception in HIV-infected women using antiretroviral therapy. AIDS 2015; 29: 2353–9. PubMed PMID: 26544706.
Cohn, SE, Park, JG, Watts, DH, et al.; ACTG 5093 Protocol Team. Depo-medroxyprogesterone in women on antiretroviral therapy: effective contraception and lack of clinically significant interactions. Clin Pharmacol Ther 2007; 81: 222–7.
Sinei, SK, Morrison, CS, Sekadde-Kigondu, C, et al. Complications of use of intrauterine devices among HIV-1–infected women. Lancet 1998; 351: 1238–41.
Panel on Antiretroviral Therapy and Medical Management of HIV-Infected Children. Guidelines for the use of antiretroviral agents in pediatric HIV infection. (accessed March 2017).

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To send content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Dropbox.

Available formats

Send book to Google Drive

To send content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Google Drive.

Available formats