Behandeling van hiv-geïnfecteerde zwangeren: preventie van virustransmissie en bijwerkingen bij moeder en kind

Without intervention, the probability of HIV transmission from mother to child varies from less than 10% to over 60%, dependent on the quantity of freely circulating HIV in the plasma. The prevention of HIV transmission from mother to child is based on the perinatal administration of a combination of antiretroviral drugs (highly active antiretroviral therapy; HAART) to both mother and child. The value of elective caesarean section along with an effective treatment with HAART during the pregnancy is very limited. Exclusive breastfeeding does not lead to a higher HIV transmission than bottle-feeding, but this effect does not lead to a successful strategy. As prophylactic treatment with HAART is widely used, it can be assumed that, in general, the use of HAART during pregnancy is relatively safe. Whether the same is true for the use of specific, and often newer drugs, is frequently not known due to the scarcity of data. For pregnant women it is important to carefully monitor adverse effects such as hepatotoxicity during the first few weeks of treatment. The most important adverse effect for the pregnancy appears to be premature birth. Yet this only occurs if HAART has to be used throughout the entire pregnancy. In the neonate mitochondrial toxicity and haematological effects can occur. These appear to be clinically insignificant but longer term effects cannot be excluded. On the basis of the available long-term safety data for children, no single antiretroviral drug has proven safety