n Southern African Journal of HIV Medicine - Safety of antiretrovirals in pregnancy : clinical




Highly active antiretroviral therapy (HAART) of three or more drugs is used extensively in industrialised countries for pregnant women with HIV, both to treat their own infection and to prevent mother-to-child transmission (MTCT). However, experts agree that current practice is based on limited randomised controlled trial data and guidelines are largely informed by observational studies and expert opinion. The British HIV Association (BHIVA) Pregnancy Guidelines note that 'The Cochrane Systematic Review of randomised controlled trials in this area shows how limited the guidelines would be were they to be restricted to such high-level evidence' (see box). Despite this, good results using HAART, showing both reduction in transmission to less than 2% and benefits to maternal health, have been reported from several cohorts and observational studies in industrialised countries.

Research and programmes from resource-limited settings have largely focused on short-course regimens of antiretrovirals in pregnancy, with the objective of reducing MTCT, but data are gradually emerging from cohorts of women from these settings receiving HAART.


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