German-Austrian Guidelines for HIV-therapy during pregnancy--status: May/June 1998--common statement of the Deutsche AIDS-Gesellschaft (DAIG) and the Osterreichische AIDS-Gesellschaft (OAG).

The same guidelines are valid for HIV-infected women during pregnancy as for HIV-infected adults. The only modification of these guidelines necessary is that treatment is indicated in clinically asymptomatic pregnant patients when the T-helper cell count is <250-400/microl. Initial therapy is a 3-drug combination including two nucleoside reverse transcriptase inhibitors (NRTI) and one protease inhibitor (PI) or one non-nucleoside reverse transcriptase inhibitor (NNRTI). Since the teratogenicity of PI and NNRTI is unclear, a virologically weaker two-drug combination consisting of 2 NRTIs can be resorted to. When therapy is pending, embryonal toxicological factors require a decision to be made in the first trimester of pregnancy as to whether a therapy pause of maximally 3 months is medically tenable for the pregnant woman. The decision should be adjusted to the risk and reached in each individual case after consulting with the future mother. The same substances can be administered when antiretroviral medication is started again, since it is unlikely that resistance will develop. To reduce the risk of vertical transmission, the following prophylactic regimen is recommended during delivery: 1) zidovudine treatment of the mother after completion of the 32nd week of pregnancy (32 + 0) at a dosage of 5 x 100 mg/day or 2 x 250 mg/day orally; if necessary, in addition to the ongoing antiretroviral therapy. 2) first-option cesarean section along with preparation of fetal membrane before onset of labor in the 36th completed week of pregnancy (36 + 0). 3) preoperative intravenous zidovudine therapy (2 mg/kg body weight). 4) postnatal zidovudine therapy of the child for 10 days intravenously (1.3 mg/kg every 6 hours) or 2-6 weeks orally (2 mg/kg every 6 hours). In exceptional obstetric cases, e.g., premature labor, premature rupture of the membranes, amniotic infection syndrome, or multiple pregnancy, cesarean section is also the preferred mode of delivery. However, the decision must be made on the basis of obstetric concerns. If prophylaxis to prevent transmission has been incomplete, at least intrapartum and postnatal treatment should be given. If the HIV status of the mother is unclear, it must be ascertained in order to administer a prophylaxis to prevent transmission if necessary. A competent consultation must always be offered, if appropriate also together with a relevant institution.