Jamieson Denise J, Clark Jill, Kourtis Athena P, Taylor Allan W, Lampe Margaret A, Fowler Mary Glenn, Mofenson Lynne M
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA 30341, USA.
Am J Obstet Gynecol. 2007 Sep;197(3 Suppl):S26-32. doi: 10.1016/j.ajog.2007.03.087.
In the United States, current human immunodeficiency virus (HIV) testing guidelines recommend an opt-out approach for pregnant women, whereby HIV testing is incorporated routinely into the standard panel of prenatal tests with the option to decline. Current recommendations for the initiation of treatment of HIV infection in pregnant women are the same as those for nonpregnant women. However, the special circumstances of pregnancy raise additional issues that are related to potential drug toxicity to the mother and fetus, which affect the choice of antiretroviral drugs to be used. For HIV-infected pregnant women who do not require therapy for their own health, antiretroviral drugs are recommended for prevention of mother-to-child transmission. Highly active antiretroviral therapy is recommended for all women with HIV RNA levels of > or = 1000 copies/mL, along with consideration of elective cesarean delivery. For women with HIV RNA levels of < 1000 copies/mL, a 3-part zidovudine prophylaxis regimen (prenatal, intrapartum, and neonatal) should be used alone or in combination with other antiretroviral drugs.
在美国，现行的人类免疫缺陷病毒（HIV）检测指南建议对孕妇采用“选择退出”的方法，即HIV检测常规纳入标准的产前检查项目，孕妇可选择拒绝检测。目前关于孕妇开始接受HIV感染治疗的建议与非孕妇相同。然而，怀孕的特殊情况引发了其他问题，这些问题与药物对母亲和胎儿的潜在毒性有关，这会影响抗逆转录病毒药物的选择。对于自身健康不需要治疗的HIV感染孕妇，推荐使用抗逆转录病毒药物来预防母婴传播。对于所有HIV RNA水平≥1000拷贝/毫升的女性，建议进行高效抗逆转录病毒治疗，并考虑选择性剖宫产。对于HIV RNA水平＜1000拷贝/毫升的女性，应单独使用三联齐多夫定预防方案（产前、产时和新生儿期）或与其他抗逆转录病毒药物联合使用。
