New recommendations aim to help pregnant women with HIV make informed choices

September 11, 2017, British Medical Journal
HIV infecting a human cell. Credit: NIH

New recommendations on antiretroviral drugs for pregnant women living with HIV can help women make more informed choices about benefits and harms, say a panel of international experts in The BMJ today.

The recommendations, which take a patient's perspective rather than a public health perspective, differ from current guidelines, and are meant to support shared decision making between and their healthcare provider, say the authors. The new guidelines suggest that most women are likely to prefer older HIV medications rather than the ones that are most often currently prescribed.

Their advice is part of The BMJ's Rapid Recommendations initiative - to produce rapid and trustworthy guidance based on new evidence to help doctors make better decisions with their patients.

Every year about 1.4 million women living with HIV become pregnant. Most women take a combination of three to reduce the risk of transmission to their child or for personal health reasons. Recent trial evidence suggested that the most commonly used combinations might increase the risk of premature birth and neonatal death compared with other drug combinations.

So an international panel - made up of women living with HIV, specialist doctors, and general practitioners - carried out a detailed analysis of the evidence to make recommendations.

Their suggestions are based on data from two systematic reviews (published in BMJ Open) that looked at the benefits and harms of different drug combinations for pregnant women with HIV and the values and preferences of women considering antiretroviral therapy.

Evidence from these reviews led the panel to recommend older alternatives instead of the most widely used to help reduce the risk of and - which almost all women said they were extremely keen to avoid.

The panel acknowledge that the number of antiretroviral therapy options that women can choose from and can be prescribed varies considerably throughout the world - and that, in many settings, alternative drugs may not be available.

They also point out that their recommendations, like all BMJ Rapid Recommendations, take a patient centred perspective. Whereas guidelines that take a public health perspective, such as the WHO guideline, need to consider resource use and might make different recommendations based on the same evidence.

And they recognise the operational challenges that alternative treatment options may introduce, particularly in low resource settings.

In conclusion, they say there is a lack of reliable trial data on the safety and efficacy of most commonly used in pregnant women living with HIV.

They call for further research to inform treatment options, as well as efforts to overcome operational challenges "so that availability of the right choice of combination is aligned with the best available for almost all pregnant women living with HIV."

In a linked opinion piece, Alice Welbourn, a researcher, trainer, writer and activist on gender and sexual and reproductive health and rights, says women's fundamental rights to informed choices about what happens to their bodies are often curiously contested; especially if they are pregnant or have HIV. Yet, informed choices about risks and benefits form a critical part of long-term prognosis.

As Founding Director of the Salamander Trust, and a woman living with HIV, she welcomes the positive response by the new WHO director-general to support more people-centred policy developments.

She urges WHO to "ensure 's rights to informed, voluntary, and confidential choice about if, when, and how to start treatment safely, which treatment to consider, and how long to take it."

Explore further: Many pregnant women search the Internet for medication safety information

More information: Rapid Recommendations: Antiretroviral therapy in pregnant women living with HIV: a clinical practice guideline, www.bmj.com/content/356/bmj.j3961

Opinion: WHO and the rights of women living with HIV, blogs.bmj.com/bmj/2017/09/11/a … omen-living-with-hiv

Related Stories

Many pregnant women search the Internet for medication safety information

September 7, 2017
A new study reveals that due to a lack of specific recommendations for medication use during pregnancy, many pregnant women search the Internet for information.

Zika vaccine research—guidance for including pregnant women

June 30, 2017
New guidance for including pregnant woman and their babies in Zika vaccine research has been published today. It has been issued by a group of international experts in vaccinology, maternal and child health, public health ...

Review: Little evidence on vitamin D-allergy association

July 13, 2017
(HealthDay)—Vitamin D supplementation seems not to prevent allergies in pregnant women, breastfeeding women, or infants, though there is very little evidence about the association between vitamin D and allergic diseases, ...

Hormone therapy not advised for preventing disease after menopause

May 17, 2017
(HealthDay)—Using hormone therapy to prevent chronic health issues, such as heart disease and bone loss, in postmenopausal women may do more harm than good, the U.S. Preventive Services Task Force (USPSTF) says.

ACP issues guideline for treating low bone density or osteoporosis to prevent fractures

May 8, 2017
The American College of Physicians (ACP) recommends in an evidence-based clinical practice guideline published today in Annals of Internal Medicine that physicians treat women with osteoporosis with bisphosphonates (alendronate, ...

Review: Effects of depression Tx in pregnancy unclear

August 11, 2014
(HealthDay)—The current evidence is inadequate for assessing the benefits and harms of depression treatment in pregnancy and the postpartum period, according to a review published online July 7 in Obstetrics & Gynecology.

Recommended for you

New simulation tool predicts how well HIV-prophylaxis will work

June 14, 2018
A new mathematical simulation approach predicts the efficacy of pre- and post-exposure prophylaxis (PrEP) medications, which help prevent HIV infection. The framework, presented in PLOS Computational Biology by Sulav Duwal ...

Many at risk for HIV despite lifesaving pill

June 11, 2018
Multiple barriers may stop high-risk individuals from accessing an HIV drug that can reduce the subsequent risk of infection, according to a new University of Michigan study.

Active HIV in large white blood cells may drive cognitive impairment in infected mice

June 7, 2018
Macrophages, large white blood cells that engulf and destroy potential pathogens, harbor active viral reserves that appear to play a key role in impaired learning and memory in mice infected with a rodent version of HIV. ...

HIV vaccine elicits antibodies in animals that neutralize dozens of HIV strains

June 4, 2018
An experimental vaccine regimen based on the structure of a vulnerable site on HIV elicited antibodies in mice, guinea pigs and monkeys that neutralize dozens of HIV strains from around the world. The findings were reported ...

HIV study reveals new group of men at risk of infection

June 4, 2018
A group of men who may be underestimating their HIV risk has been identified in a new study.

Discovery reveals how cells try to control levels of key HIV protein

May 31, 2018
One of the many challenges in treating HIV is that the virus can lie dormant in cells, quietly evading immune detection until it suddenly roars to life without warning and begins replicating furiously. Salk Institute researchers ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.