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Care of HIV-Infected Pregnant Women in Maternal–Fetal Medicine Programs英文文献资料
InfectDisObstetGynecol2001;9:81–87
CareofHIV-infectedpregnantwomeninmaternal–fetal
medicineprograms
PeterA.Sklar
1
,SusanneL.Bathgate
2 3 1
,HeatherA.Young andDavidM.Parenti
1
DivisionofInfectiousDiseases,DepartmentofMedicine,and
2
DivisionofMaternal-FetalMedicine,
DepartmentofObstetricsandGynecology,TheGeorgeWashingtonUniversitySchoolofMedicineand
HealthSciences,Washington,DC
3
DepartmentofBiostatistics,TheGeorgeWashingtonUniversitySchoolofPublicHealthand
HealthServices,Washington,DC
Objective: Tosurveytheevolutionoverthepastdecadeofattitudesandpracticesofobstetriciansinmaternal–
fetalmedicinefellowshipprogramsregardingthemanagementofhumanimmunodeficiencyvirus(HIV)-infected
pregnantwomen.
Methods: Directors of all 65 approved maternal–fetal medicine training programs were sentquestionnaires,
responsestowhichweretoreflecttheconsensusamongmembersoftheirfaculties.Programswerestratified
baseduponthenumberofHIV-infectedpregnantpatientscaredforinthepreviousyear.
Results: Responsesreflectexperiencewithover1000infectedpregnantwomenperyear,nearlyone-quarterwith
advanceddisease.Combinationantiretroviraltherapywasprescribedbyallrespondents,universallyinthe2ndand
3rdtrimesters.Athree-drugregimen(oftencontainingaproteaseinhibitor)wasusedmoreoftenbythosewho
treatedatleast20HIV-infectedpregnantpatientsperyearthan bythoseprogramsseeingalowernumberof
patients(80vs59%).Despitetheknownandunknownrisksoftheuseofantiretroviralsduringpregnancy,onlyhalf
ofallrespondingprogramsreportadverseeventstotheAntiretroviralPregnancyRegistry;reportingwasmore
commonamongtheinstitutionsseeingahighernumberofpatients(61vs45%).Seventy-eightpercentofhigher
volume programs enroll their patients in clinical studies, usually multicenter, versus 35% of lower volume
programs.
Conclusions: Care for HIV+ pregnantwomen has dramatically changedover the pastdecade. Antiretroviral
therapy is now universally prescribed by physicians involved in maternal–fetal medici
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