HAART during pregnancy and during breastfeeding among HIV-infected women in the developing world: has the time come?

摘要

There are as yet no definitive data from randomized controlled trials with clinical end points to inform when to optimally start HAART in asymptomatic HIV-infected patients [1,2]. However, the advent of more potent and better-tolerated antiretroviral drugs has led to a strong push toward earlier initiation of HAART. This trend has been driven primarily by findings from large prospective cohort studies [3-5] in the United States and elsewhere showing lower mortality and fewer adverse events associated with initiation of HAART at higher CD4 cell counts. During pregnancy, healthcare providers in high-income countries recommend initiation of HAART for all HIV-infected women in order to reduce viral load, improve maternal health, and prevent perinatal HIV transmission [1,6]. In resource-poor settings, initiating HAART has been recommended only for pregnant women with more advanced HIV disease [i.e., CD4 cell count < 200 cells/mul (<250 cells/mul in some countries such as Malawi) or HIV-related symptoms and CD4 cell count < 350 cells/mul] [7].