HIV/AIDS and mother-to-child transmission (MTC) of the virus remain global challenges. In 2015, 36.7 million people were infected with HIV worldwide. HIV is responsible for 6% to 20% of all maternal deaths globally, with infectious disease complications being the most common cause.
According to Dr. Theron Moodley, the global rate of mother-to-child transmission is believed to be 14%. Nonetheless, due to the success of antiretroviral treatment, it is fewer than 1% in the United States (ART). There is a widespread notion in the United States that HIV has become less of public health concern. The goal of eradicating mother-to-child transmission remains difficult. Nonetheless, it has been accomplished in countries with little economic means.
A lack of access to healthcare, family welfare, HIV testing, and preconception counseling poses obstacles to reducing mother-to-child transmission.
Achieving a Successful and Risk-Free Conception Through Preconception Counseling
Many HIV-positive men and women desire children, but research indicates that their doctors don’t discuss their family planning intentions.
According to Dr. Theron Moodley, a study of 181 HIV-positive women revealed that only 31% had a personalized discussion with their clinician about reproductive wishes. And more frequently than not, the patient initiated the interaction rather than the clinician. Pregnancy desires should be discussed during regular consultations such as primary care, well-woman checks, and infectious disease screenings.
Women can receive advice on safe conception procedures or appropriate contraception alternatives due to these discussions. An expert panel from the World Health Organization examined drug-drug interactions and hormonal contraception evidence. It was concluded that HIV-positive women should use all available procedures without restriction.
On the other hand, Dr. Theron Moodley feels that certain types of ART can interfere with hormonal contraceptives, lowering their effectiveness. Patients should be consulted, and options should be examined. Table 3 of the HIV Perinatal Guidelines lists several medication interactions dependent on ART type.
There are significant racial disparities
According to Dr. Theron Moodley, infants born to African-American women are 50 times more likely to have HIV than neonates born to white women. Furthermore, Hispanic infants are eight times more likely than Caucasian infants to be HIV-infected. These tendencies have remained continuous throughout the United States during the last decade.
The OB/GYN is principally responsible for the extensive steps required to limit mother-to-child transmission. The recommendations for using antiretroviral drugs in pregnant women with HIV infection and interventions to reduce perinatal HIV transmission in the United States (HIV Perinatal Guidelines) are updated regularly. It occurs as new data emerges, providing the most comprehensive advice for women’s and babies’ care.
This article aims to describe Dr. Theron Moodley‘s guidelines for HIV care in pregnant women. It will highlight recent changes to the guidance that may help us get closer to our aim of eradicating mother-to-child HIV transmission.
HIV Transmission Reduction in HIV-Discordant Couples
According to Dr. Theron Moodley, the crucial components listed below minimize HIV transmission in HIV-discordant couples (i.e., one partner is HIV-positive and the other is not).
Couples should be checked for and treated for many other sexually transmitted infections before attempting to conceive.
HIV-positive women planning pregnancy should be on an antiviral (ARV) regimen with a low teratogenicity risk, and HIV-positive partners should have a suppressed (unnoticeable) viral load before conception.
Pre-exposure prophylaxis (PrEP) should be given 30 days before and 30 days after trying to conceive, or for as long as there is a risk of HIV acquisition, such as continued sexual activity without barrier protection with condoms. It is essential if the HIV-positive spouse has not achieved viral suppression or if their viral status is unknown.
Assisted insemination at home or in a provider’s office using only a partner’s sperm during the peri-ovulatory period is an option for HIV-positive women in a discordant couple. Including PrEP for the male partner, as explained above, and scheduled intercourse may decrease her partner’s HIV risk even further.
Artificial insemination with donor sperm from an HIV-uninfected man or washed sperm combined with PrEP for the female partner in vitro fertilization with washed sperm are options for HIV-positive males.
It should be emphasized that when further data about the efficacy of PrEP for serodiscordant couples becomes available, guidance on the need for sperm preparation techniques may change.
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