German-Austrian recommendations for HIV-therapy in pregnancy--common declaration of The German AIDS-society (DAIG), The Austrian AIDS-society (OEAG) as well as The Robert-Koch Institute Berlin (RKI), The German Association of Physicians specialized in HIV Care (DAGNAE), The German Society of Pediatric and Youth Medicine (DGKJ), The German AIDS Pediatric Association (PAAD), The German Society of Obstetrics and Gynecology (DGGG), The National Reference Center for Retroviruses (NRZ), German AIDS Assistance (DAH)

Abstract

Anti-retroviral therapy during pregnancy--The German/Austrian recommendations to optimise prevention of vertical transmission of HIV and to minimise adverse drug effects. In Germany during the last years about 200 HIV infected pregnant women delivered a baby each year, a number that is currently increasing. To determine the HIV-status early in pregnancy voluntary HIV-testing of all pregnant women is recommended in Germany and Austria as part of prenatal care. In those cases, where HIV infection was known during pregnancy, since 1995 the rate of vertical transmission of HIV was reduced to 1-2%. This low transmission rate has been achieved by the combination of anti-retroviral therapy of pregnant women, cesarean section scheduled before onset of labor, anti-retroviral prophylaxis in the newborn and refraining from breast-feeding by the HIV infected mother. In 1998 an interdisciplinary consensus meeting consisting of gynaecologists, infectious disease specialists, paediatricians, pharmacologists, virologists and members of the German AIDS Hilfe (NGO) updated this combined strategy for the first time. A second update became necessary because of new results in research, approval of new anti-retroviral drugs and changes in the general treatment recommendations for HIV infected adults, which are referred to in the pregnancy guidelines. The updating process was started in July 2000 and was finalized in May 2001. In the updated guidelines recommendations for monitoring of HIV infected pregnant women in prenatal care and for preventive procedures for the newborn in delivery room have been included. The guidelines provide new recommendations on the indication and the starting point for anti-retroviral therapy in pregnancies without complications, drugs and drug combinations to be used preferably in these pregnancies and updated information on adverse effects of anti-retroviral drugs. Also the procedures for different scenarios and risk constellations in pregnancy have been specified. With these current guidelines in Germany and Austria the low rate of vertical HIV-transmission should be further maintained.