Resumo
Definição
病史和体格检查
关键诊断因素
- increased risk of maternal HIV infection
- increased risk of perinatal HIV transmission
其他诊断因素
- oral candidiasis
- increasing dyspnea
- weight loss
- fever
- malaise
- lymphadenopathy
- maculopapular blanching rash
危险因素
- needle-sharing with injection drug use
- unprotected receptive penile-vaginal intercourse
- unprotected receptive anal intercourse
- percutaneous needle stick
- sexually transmitted infections (STIs) and bacterial vaginosis
- high maternal viral load (perinatal transmission)
- absence of prenatal maternal antiretroviral therapy (perinatal transmission)
- breast-feeding in mothers without viral suppression (perinatal transmission)
- violence against women and girls
- receptive oral intercourse
- insertive oral intercourse
- multiple sexual partners
- low maternal CD4 count (perinatal transmission)
诊断性检查
首要检查
- maternal HIV-1/HIV-2 antigen/antibody enzyme-linked immunosorbent assay (ELISA)
- maternal HIV-1/HIV-2 antibody differentiation immunoassay
- neonatal HIV DNA or RNA polymerase chain reaction (PCR)
需考虑的检查
- HIV-1 western blot
- HIV-1 indirect immunofluorescence assay (IFA)
- HIV-1 nucleic acid test (NAT)
- CD4 count
- plasma HIV RNA levels (viral load)
- renal function tests
- liver function tests (LFTs)
- drug resistance tests
- complete blood count
- glucose screening
- fetal ultrasound
- tests for coinfections
治疗流程
HIV-1-infected pregnant women: <38 weeks not in labor (regardless of HIV RNA level)
HIV-1-infected pregnant women with HIV-1 RNA levels >1000 copies/mL: at 38 weeks or in labor
HIV-1-infected pregnant women with HIV-1 RNA levels ≤1000 copies/mL: at 38 weeks or in labor
infants born to HIV-infected mothers
撰稿人
作者
Rachel K. Scott, MD, MPH, FACOG
Associate Professor of Obstetrics and Gynecology
Georgetown University School of Medicine
Scientific Director of Women’s Health Research
MedStar Health Research Institute
Associate Chair for Research
MedStar Washington Hospital Center Department of Women’s and Infants’ Services
Washington
DC
利益声明
RKS declares that she has participated in an advisory meeting for ViiV Healthcare and has received research funding from ViiV, managed by MedStar Health Institute.
鸣谢
Dr Rachel K. Scott would like to gratefully acknowledge Dr Isaac Delke, Dr Christina Bailey, and Dr Mettassebia Kano, the previous contributors to this topic.
利益声明
ID, CB, and MK declare that they have no competing interests.
同行评议者
Aisha Sethi, MD
Assistant Professor of Medicine
Associate Residency Program Director
University of Chicago
Chicago
IL
利益声明
AS declares that she has no competing interests.
Graham P. Taylor, MBChB, FRCP, FHEA
Reader in Communicable Diseases
Faculty of Medicine
Imperial College
London
UK
利益声明
GPT has been reimbursed by various pharmaceutical companies for attending conferences, lecturing, and consulting, and has been chief investigator of investigator-initiated industry-funded research on HIV and pregnancy.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission. Recommendations for the use of antiretroviral drugs during pregnancy and interventions to reduce perinatal HIV transmission in the United States. Jan 2024 [internet publication].全文
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Infectious mononucleosis
- Toxoplasmosis
- Viral hepatitis
更多 鉴别诊断Guidelines
- Recommendations for the use of antiretroviral drugs during pregnancy and interventions to reduce perinatal HIV transmission in the United States
- Care of pregnant women living with HIV and interventions to reduce perinatal transmission
更多 GuidelinesPatient information
HIV infection in pregnancy
More Patient information
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