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


1: Exclude Dideoxycytosine and Efavirenz; 2: Exclude Didanosine+Stavudine
*: with specific recommendations for premature newborn and/or in case of intravenous administration
VL: viral load, MCT: mother to child transmission, WA: weeks of amenorrhea, ECS: Elective caesarean section, WA : weeks of amenorrhea, NVP: nevirapine, NFV: nelfinavir,
LPV: lopinavir/low dose ritonavir
Table 1: Evolution of the French recommendations for the prevention of HIV-1 mother to child transmission
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