Care of HIV-Infected Pregnant Women in Maternal–Fetal Medicine Programs

[摘要] Objective:To survey the evolution over the past decade of attitudes and practices of obstetricians in maternal–fetal medicine fellowship programs regarding the management of human immunodeficiency virus (HIV)-infectedpregnant women.Methods:Directors of all 65 approved maternal–fetal medicine training programs were sent questionnaires,responses to which were to reflect the consensus among members of their faculties. Programs were stratifiedbased upon the number of HIV-infected pregnant patients cared for in the previous year.Results:Responses reflect experience with over 1000 infected pregnantwomen per year, nearly one-quarter withadvanced disease. Combination antiretroviral therapy was prescribed by all respondents, universally in the 2nd and3rd trimesters. A three-drug regimen (often containing a protease inhibitor) was used more often by those whotreated at least 20 HIV-infected pregnant patients per year than by those programs seeing a lower number ofpatients (80 vs 59%).Despite the known and unknown risks of the use of antiretrovirals during pregnancy, only halfof all responding programs report adverse events to the Antiretroviral Pregnancy Registry; reporting was morecommon among the institutions seeing a higher number of patients (61 vs 45%). Seventy-eight percent of highervolume programs enroll their patients in clinical studies, usually multicenter, versus 35% of lower volumeprograms.Conclusions:Care for HIV² pregnant women has dramatically changed over the past decade. Antiretroviraltherapy is now universally prescribed by physicians involved in maternal–fetal medicine training programs.Given limited experience with these agents in the setting of pregnancy, it is essential for maternal–fetal medicinepractitioners to actively report on adverse events and participate in clinical trials.

[学科分类] 妇产科学