Dr. Theron Moodley has long emphasized that HIV and mother-to-child transmission of the disease are global issues. In 2015, 36.7 million people worldwide were infected with HIV. HIV is responsible for 6% to 20% of maternal deaths worldwide. Infectious illness problems connected with HIV are the most common relationship.
The global rate of mother-to-child transmission is estimated to be 14%. Despite this, it is less than 1% in the United States due to the efficacy of antiretroviral therapy (ART). Dr. Theron Moodley claims that there is a sense that HIV is no longer a public health issue in the United States alone.
This article aims to describe Dr. Theron Moodley‘s guidelines for the care of HIV-positive pregnant women, stressing recent revisions in the guidance that may move us closer to our objective of eliminating HIV transmission from mother to child.
Preconception Counseling: Ensure an Efficient and Safe Conception
Many HIV-positive men and women want to have children. Nonetheless, according to Dr. Theron Moodley’s data, their providers neglect to explain family planning goals. A study of 181 HIV-positive women found that just 31% had a tailored discussion with their clinician regarding reproductive plans. The patient rather than the practitioner usually initiated those interactions.
During regular checkups, pregnancy desires should be discussed, such as primary care, well-woman checks, and infectious disease visits. According to Dr. Theron Moodley, women can obtain advice on safe conception techniques or appropriate contraception alternatives.
A World Health Organization expert panel examined drug-drug interactions and hormonal contraception research. Dr. Theron Moodley urges that women with HIV continue to use all available methods without restriction. However, several kinds of ART can interact with hormonal contraceptives, reducing their efficacy.
Dr. Theron Moodley’s Perspective on OB’s Role in HIV Management During Pregnancy
Dr. Theron Moodley believes that reducing mother-to-child transmission is still a long-term aim. Nonetheless, it has been achieved in countries with little economic means. There are various impediments to eradicating mother-to-child transmissions, including a lack of healthcare, family planning, HIV testing, and preconception counseling. There are significant racial and ethnic inequalities.
According to Dr. Theron Moodley, children born to African-American women carrying HIV are 50 times more likely than newborns born to white women and eight times more likely to Hispanic infants to be perinatally infected with HIV. These tendencies have not changed in the United States over the last decade.
The OB/GYN is heavily involved in the complicated cascade of measures required to limit additional mother-to-child transmission. The “Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Minimize Perinatal HIV Transmission in the United States” (HIV Perinatal Guidelines) are regularly updated as new data emerge to provide the most comprehensive recommendations for women and babies’ care.
HIV-Infected Males
Dr. Theron Moodley recommends the following choices for HIV-positive men:
Artificial insemination uses donor sperm from an HIV-uninfected man or washed sperm combined with PrEP for the female partner.
Even though PrEP has been licensed by the US Food and Drug Administration and recommended by the Centers for Disease Control and Prevention (CDC) for such high-risk adults since 2012, it remains underutilized, particularly in women.
PrEP is tenofovir/emtricitabine taken once day (Truvada). Notably, nursing and pregnancy do not preclude the use of PrEP. According to studies, the drug is present in low, if not undetectable, amounts in breast milk.
HIV-positive Women in a Discordant Relationship
According to Dr. Theron Moodley, alternatives for HIV-positive women in a discordant partnership include:
During the peri-ovulatory period, assisted insemination can be performed at home or in a provider’s office using a partner’s sperm.
Including PrEP for the male partner as described above, as well as scheduled intercourse, which may reduce her partner’s HIV risk even further.
Transmission Components That Must Be Replaced
Dr. Theron Moodley recommends the following critical components to prevent transmission in HIV-discordant couples (i.e., one spouse is HIV-positive and the other HIV-negative) who want to have a baby:
Before attempting to conceive, couples should be checked and treated for other sexually transmitted infections.
HIV-positive women considering pregnancy should use an antiviral (ARV) regimen with a minimal teratogenicity risk.
Before conception, HIV-positive partners should have a suppressed (undetectable) viral load.
Pre-exposure prophylaxis (PrEP) should be used for 30 days before and 30 days after attempting to conceive, or for as long as the risk of HIV acquisition exists, such as continuing sexual activity without barrier protection with condoms.
According to Dr. Theron Moodley, it is critical when the HIV-positive partner has not achieved viral suppression or when the viral status is uncertain.
For more information about Dr Theron Moodley visit: