Article

Management of HIV positive pregnancies in Ontario: current status.

Department of Pharmaceutical Sciences, Faculty of Pharmacy, University of Toronto, Toronto, Canada.
The Canadian journal of clinical pharmacology = Journal canadien de pharmacologie clinique 02/2009; 16(1):e68-77.
Source: PubMed

ABSTRACT AIDS is one of the biggest health crises we face today. With nearly 20 million women infected with the virus that causes it, HIV, maternal transmission of HIV is increasingly becoming a serious concern and hindrance in stemming the proliferation of the disease. While an ever increasing number of pregnant women are being administered anti-retrovirals to mitigate the vertical transmission of the virus, little is known about the changing trends in the type of agents used and the duration of therapy.
This paper attempts to identify any changes in the pattern of HIV management in pregnant women for the period of time spanning 1998 to 2005.
Data from the charts of 183 patients were reviewed. A retrospective, longitudinal and cross-sectional patient chart review was employed to obtain data. Parameters such as therapeutic management of HIV, class of drugs used and duration of treatment were assessed to identify any evolving patterns over the course of the study.
It was seen that over time, the number of women receiving adequate therapeutic interventions has steadily increased. We also identified evolving trends in terms of the classes of anti-retrovirals employed and the duration of prophylaxis.
The strategies employed in the management of HIV positive pregnancies in Ontario, while evolving over time, were found to be in line with the guidelines in place. The information delivered by this study might enable the medical community to assess the progress in dealing with this challenge thus far and further fine tune the current strategy.

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    ABSTRACT: To evaluate whether the length of time of rupture of membranes (ROM) in optimally managed HIV-positive women on highly active antiretroviral therapy (HAART) with low viral loads (VL) is predictive of the risk of mother to child transmission (MTCT) of the human immunodeficiency virus (HIV). A retrospective case series of all HIV-positive women who delivered at two academic tertiary centers in Toronto, Canada from January 2000 to November 2010 was completed. Two hundred and ten HIV-positive women with viral loads <1,000 copies/ml delivered during the study period. VL was undetectable (<50 copies/mL) for the majority of the women (167, 80%), and <1,000 copies/mL for all women. Mode of delivery was vaginal in 107 (51%) and cesarean in 103 (49%). The median length of time of ROM was 0.63 hours (range 0 to 77.87 hours) for the entire group and 2.56 hours (range 0 to 53.90 hours) for those who had a vaginal birth. Among women with undetectable VL, 90 (54%) had a vaginal birth and 77 (46%) had a cesarean birth. Among the women in this cohort there were no cases of MTCT of HIV. There was no association between duration of ROM or mode of delivery and MTCT in this cohort of 210 virally suppressed HIV-positive pregnant women.
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