|
1996 |
1999 |
2002 |
2004 |
2006 |
2008 |
2010 |
Main
concept |
Implementation of protocol ACTG076-ANRS024 (33) |
Long term follow-up of infant exposed to NRTI in utero |
Start HAART after 12 WA.
Infant follow-up |
HAART only
No mono or dual therapy |
Concern about toxicity of HAART on mother and infant |
Same concept
Few changes |
Same concept
Few changes |
Treatment regimen during pregnancy for women who weren’t treated before pregnancy |
Start AZT on the 14th week of pregnancy |
Start AZT or AZT+3TC on the 14th week of pregnancy |
If maternal VL<10,000c/ml: AZT + ECS
If maternal VL>10,000 c/ml : HAART |
Start HAART at the beginning of 3rd trimester of pregnancy |
Start HAART before 28 WA, or before 20 WA if risk of prematurity |
Start HAART, before 26 WA, or before 20 WA if risk of prematurity |
= 2008 |
Treatment regimen during pregnancy for women who were treated before pregnancy |
In case of bitherapy: stop one NRTI until the end the 3rd trimester of pregnancy.
Stop any PI (ritonavir or indinavir) |
Same treatment if good efficacy and tolerance.
If CD4<350/ml or VL>5.000 c/ml: treatment change1 |
Same treatment if good efficacy and tolerance.
If CD4<350/ml or VL>400 c/ml, treatment change2 |
Same treatment if good efficacy and tolerance.
If VL>400 c/ml, treatment change2 |
Same treatment if good efficacy and tolerance.
If VL>50 c/ml, treatment change2 |
No Change |
= 2008 |
Route of delivery |
No recommendation |
No recommendation but ECS seems to reduce the risk of MCT |
ECS if VL>400c/ml under HAART or if AZT alone during pregnancy |
ECS only if VL>400c/ml under HAART just before delivery
|
ECS only if VL>50c/ml under HAART just before delivery
|
ECS if VL>400c/ml |
= 2008 |
Treatment during delivery |
Intravenous AZT |
= 1996 |
= 1996 |
= 1996 |
= 1996 |
= 1996 |
= 1996 |
Treatment for the newborn |
AZT: 2 mg/kg four time a days- 6 weeks |
AZT: same dose
+ 3TC in MCT high risk situations |
AZT: same dose
+ 3TC or NVP if maternal VL> 1,000c/ml at delivery |
AZT*: same dose
+ 3TC and NFV or NVP if maternal VL> 1,000c/ml at delivery or no maternal treatment |
= 2004 |
AZT*: same dose
+ 3TC and LPV or NVP if maternal VL>1,000c/ml at delivery or no maternal treatment |
Same concept.
Reduction of AZT post-natal exposure to 4 weeks |
