Pregnancy and HIV infection
Yıl 2016,
Cilt: 25 Sayı: 4, 522 - 535, 31.12.2016
Mete Sucu
,
Cihan Çetin
Mehmet Özsürmeli
Ghanim Khatib
Ceren Çetin
Cüneyt Evrüke
Öz
The management of Human Immunodeficiency Virus (HIV) infection is progressing rapidly. In developed countries, the perinatal transmission rates have decreased from 20-30% to 1-2% with the use of antiretroviral therapy and cesarean section. Interventions for the prevention of prenatal transmission has made the prenatal care of pregnant patients with HIV infection more complex. Rapid development of standard care and continuing increase in the distribution of HIV infection has required clinicians taking care of pregnants to have current information. Therefore, in our review we aimed to summarize the prenatal course, treatment and preventive methods for perinatal transmission of HIV.
Kaynakça
- WHO. Global Report: UNAIDS Report on the Global AIDS Epidemic. Geneva, Who, 2013
- De Cock KM, Jaffe HW, Curran JW. The evolving epidemiology of HIV/AIDS. AIDS. 2012;26:1205- 13.
- Fenton KA. Changing epidemiology of HIV/AIDS in the United States: implications for enhancing and promoting HIV testing strategies. Clin Infect Dis. 2007;45:213-20.
- Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. August , 2014. http://aidsinfo.nih.gov/contentfiles/lvguidelines/PerinatalGL.pdf. (erişim tarihi:Şubat 2016)
- Hare B. Clinical overview of HIV disease: introduction and history. http://www.hivinsite.ucsf.edu. (erişim tarihi:Şubat 016)
- WHO. UNAIDS Report on the Global AIDS epidemic, 2010. Geneva. Accessible at: http://www.unaids.org/globalreport/Global_report.htm.
- World Health Organization, Unicef. Guidance on global scale-up of the prevention of mother to child transmission of HIV: towards universal access for women, infants and young children and eliminating HIV and AIDS among children / Inter-Agency Task Team on Prevention of HIV Infection in Pregnant Women, Mothers and their Children. WHO, 2007, Switzerland. Http://www.unicef.org/aids/fi les/PMTCT_enWEBNov26.pdf. (erişim tarihi:Şubat 2016).
- Mofenson L, Taylor AW, Rogers M. Achievements in public health. Reduction in perinatal transmission of HIV infection- United States, 1985-2005. MMWR Morb Mortal Wkly Rep. 2006;55:592-7.
- Sütçü M, Aktürk H, Somer A, Törün SH, İnce Z, Çoban A et al. Anneden bebeğe HIV geçişi: sekiz yıllık deneyim. Mikrobiyol Bul. 2015;49:542-53.
- Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States.Panel onTreatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission;2014. http://aidsinfo.nih.gov/guidelines/html/3/perinatal-guidelines/0/ (erişim tarihi: Şubat 2016).
- Gale HB, Gitterman SR, Hoffman HJ, Gordin FM, Benator DA, Labriola AM. Is frequent CD4+ T- lymphocyte count monitoring necessary for persons with counts >=300 cells/μL and HIV-1 suppression? Clin Infect Dis. 2013;56:1340-3.
- Cooper ER, Charurat M, Mofenson L, Hanson CI, Pitt J, Diaz C. Combination antiretroviral strategies for the treatment of pregnant HIV-1-infected women and prevention of perinatal HIV- 1 transmission. J Acquir Immune Defic Syndr. 2002:29:484-94.
- The International Perinatal HIV Group .The mode of delivery and the risk of vertical transmission of human immunodeficiency virus type 1--a meta-analysis of 15 prospective cohort studies. N Engl J Med. 1999;340:977-87.
- The National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America.Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: Recommendations from the Centers for Disease Control and Prevention.2015 http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf (erişim tarihi:Şubat 2016).
- Bonacini M, Lin HJ, Hollinger FB. Effect of coexisting HIV-1 infection on the diagnosis and evaluation of hepatitis C virus. J Acquir Immune Defic Syndr. 2001;26:340-4.
- Thio CL, Nolt KR, Astemborski J, Vlahov D, Nelson KE, Thomas DL. Screening for hepatitis C virus in human immunodeficiency virus-infected individuals. J Clin Microbiol. 2000;38:575-7.
- Mwapasa V, Rogerson SJ, Kwiek JJ, Wilson PE, Milner D, Molyneux ME. Maternal syphilis infection is associated with increased risk of mother-to-child transmission of HIV in Malawi. AIDS. 2006;20:1869-77.
- Tuomala RE, Watts DH, Li D, Vajaranant M, Pitt J, Hammill H. Improved obstetric outcomes and few maternal toxicities are associated with antiretroviral therapy, including highly active antiretroviral therapy during pregnancy. J Acquir Immune Defic Syndr. 2005;38:449-73.
- Pickering LK, Baker CJ, Freed GL, Gall SA, Grogg SE, Poland GA. Immunization programs for infants, children, adolescents, and adults: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2009;49:817-40.
- Ford N, Shubber Z, Jao J, Abrams EJ, Frigati L, Mofenson L. Safety of cotrimoxazole in pregnancy: a systematic review and meta-analysis. J Acquir Immune Defic Syndr. 2014;66:512-21.
- Floridia M, Ravizza M, Pinnetti C, Tibaldi C, Bucceri A, Anzidei G. Treatment change in pregnancy is a significant risk factor for detectable HIV-1 RNA in plasma at end of pregnancy. HIV Clin Trials. 2010;11:303-11.
- Antiretroviral Pregnancy Registry Steering Committee. Antiretroviral Pregnancy Registry International Interim Report for 1 January 1989 through 31 January 2015. Wilmington, NC: Registry Coordinating Center; 2015. www.APRegistry.com (erişim tarihi:Şubat 2016).
- Ekoukou D, Khuong-Josses MA, Ghibaudo N, Mechali D, Rotten D. Amniocentesis in pregnant HIV- infected patients. Absence of mother-to-child viral transmission in a series of selected patients. Eur J Obstet Gynecol Reprod Biol. 2008;140:212-7.
- Maiques V, García-Tejedor A, Perales A, Córdoba J, Esteban RJ. HIV detection in amniotic fluid samples. Amniocentesis can be performed in HIV pregnant women? Eur J Obstet Gynecol Reprod Biol. 2003;108:137-41.
- European Collaborative Study. Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy. Clin Infect Dis. 2005;40:458-65.
- Townsend CL, Cortina-Borja M, Peckham CS, de Ruiter A, Lyall H, Tookey PA. Low rates of mother- to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000-2006. AIDS. 2008;22:973-81.
- Cotter AM, Brookfield KF, Duthely LM, Gonzalez Quintero VH, Potter JE, O'Sullivan MJ . Duration of membrane rupture and risk of perinatal transmission of HIV-1 in the era of combination antiretroviral therapy. Am J Obstet Gynecol. 2012;207:482.e1-5.
- Briand N, Jasseron C, Sibiude J, Azria E, Pollet J, Hammou Y. Cesarean section for HIV-infected women in the combination antiretroviral therapies era, 2000-2010. Am J Obstet Gynecol. 2013;209:335.e1-12.
- European Mode of Delivery Collaboration. Elective caesarean-section versus vaginal delivery in prevention of vertical HIV-1 transmission: a randomised clinical trial. Lancet. 1999; 353:1035-9.
- Kourtis AP, Bulterys M, Nesheim SR, Lee FK . Understanding the timing of HIV transmission from mother to infant. JAMA. 2001;285:709-12
- American College of Obstetricians and Gynecologists. Committee Opinion No. 635. Prenatal and perinatal human immunodeficiency virus testing: expanded recommendations. Obstet Gynecol. 2015;125:1544–7.
- Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. August 06, 2015. http://aidsinfo.nih.gov/guidelines/html/3/perinatal-guidelines/0/ (erişim tarihi: Şubat 2016).
- Briand N, Warszawski J, Mandelbrot L, Dollfus C, Pannier E, Cravello Let al. Is intrapartum intravenous zidovudine for prevention of mother-to-child HIV-1 transmission still useful in the combination antiretroviral therapy era? Clin Infect Dis. 2013;57:903-14.
- Wong VV. Is peripartum zidovudine absolutely necessary for patients with a viral load less than 1,000 copies/ml? J Obstet Gynaecol. 2011;31:740-2.
- Nielsen-Saines K, Watts DH, Veloso VG, Bryson YJ, Joao EC, Pilotto JHet al. Three postpartum antiretroviral regimens to prevent intrapartum HIV infection. N Engl J Med. 2012;366:2368-79.
- John-Stewart GC. When is replacement feeding safe for infants of HIV-infected women? PLoS Med. 2007;4:e30.
- Connor EM, Sperling RS, Gelber R, Kiselev P, Scott G, O'Sullivan MJ et al. Reduction of maternal- infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. N Engl J Med. 1994; 331:1173-80.
- Moodley D, Pillay K, Naidoo K, Moodley J, Johnson MA, Moore KHet al. Pharmacokinetics of zidovudine and lamivudine in neonates following coadministration of oral doses every 12 hours. J Clin Pharmacol. 2001;41:732-41.
- Petra Study Team. Efficacy of three short-course regimens of zidovudine and lamivudine in preventing early and late transmission of HIV-1 from mother to child in Tanzania, South Africa, and Uganda (Petra study): a randomised, double-blind, placebo-controlled trial. Lancet. 2002;359:1178-86.
- Siberry GK, Williams PL, Mendez H, Seage GR 3rd, Jacobson DL, Hazra Ret al. Safety of tenofovir use during pregnancy: early growth outcomes in HIV-exposed uninfected infants. AIDS. 2012;26:1151-9.
- Siberry GK, Jacobson DL, Kalkwarf HJ, Wu JW, DiMeglio LA, Yogev Ret al. Lower Newborn Bone Mineral Content Associated With Maternal Use of Tenofovir Disoproxil Fumarate During Pregnancy. Clin Infect Dis. 2015;61:996-1003.
- Ford N, Mofenson L, Shubber Z, Calmy A, Andrieux-Meyer I, Vitoria M et al. Safety of efavirenz in the first trimester of pregnancy: an updated systematic review and meta-analysis. AIDS. 2014;28:123-31.
- Taylor N, Touzeau V, Geit M, Gisinger M, Egle A, Greil Ret al. Raltegravir in pregnancy: a case series presentation. Int J STD AIDS. 2011;22:358-60.
- Blonk MI, Colbers AP, Hidalgo-Tenorio C, Kabeya K, Weizsäcker K et al. Raltegravir in HIV-1- infected pregnant women: pharmacokinetics, safety, and efficacy. Clin Infect Dis. 2015;61:809- 16.
- McKeown DA, Rosenvinge M, Donaghy S, Sharland M, Holt DW, Cormack I et al. High neonatal concentrations of raltegravir following transplacental transfer in HIV-1 positive pregnant women. AIDS. 2010;24:2416-8.
- Westling K, Pettersson K, Kaldma A, Navér L. Rapid decline in HIV viral load when introducing raltegravir-containing antiretroviral treatment late in pregnancy. AIDS Patient Care STDS. 2012;26:714-7.
- Correspondence Address / Yazışma Adresi Mete Sucu
- Çukurova Üniversitesi Tıp Fakültesi
- Kadın Hastalıkları ve Doğum ABD Adana
- e-mail: metesucu@yahoo.com
- Geliş tarihi/ Received: 23.02.2016
- Kabul tarihi/Accepted: 04.04.2016
Gebelik ve HIV enfeksiyonu
Yıl 2016,
Cilt: 25 Sayı: 4, 522 - 535, 31.12.2016
Mete Sucu
,
Cihan Çetin
Mehmet Özsürmeli
Ghanim Khatib
Ceren Çetin
Cüneyt Evrüke
Öz
Human Immunodeficiency Virus (HIV) enfeksiyonunun yönetimi hızlı şekilde değişim göstermeye
devam etmektedir. Gelişmiş ülkelerdeki perinatal geçiş oranları, antiretroviral tedavi (ART) ve sezaryen
doğumun planlanmasıyla %20-30’lardan, %1-2’lere kadar düşürülmüştür. Perinatal geçişin
azaltılması için yapılan girişimler HIV ile enfekte kadınlar için uygulanan prenatal bakımı daha
kompleks hale getirmiştir. Standart bakımın çok hızlı değişmesi ve HIV enfeksiyonu yaygınlığının
giderek artması nedeniyle gebe takibi yapan klinisyenlerin bu konudaki güncel bilgilere sahip olması
önemlidir. Bu nedenle makalemizde, HIV enfeksiyonunun prenatal dönemdeki seyri, tedavisi ve
perinatal geçişin önlenmesi için alınacak tedbirleri özetlemeyi amaçladık.
Kaynakça
- WHO. Global Report: UNAIDS Report on the Global AIDS Epidemic. Geneva, Who, 2013
- De Cock KM, Jaffe HW, Curran JW. The evolving epidemiology of HIV/AIDS. AIDS. 2012;26:1205- 13.
- Fenton KA. Changing epidemiology of HIV/AIDS in the United States: implications for enhancing and promoting HIV testing strategies. Clin Infect Dis. 2007;45:213-20.
- Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. August , 2014. http://aidsinfo.nih.gov/contentfiles/lvguidelines/PerinatalGL.pdf. (erişim tarihi:Şubat 2016)
- Hare B. Clinical overview of HIV disease: introduction and history. http://www.hivinsite.ucsf.edu. (erişim tarihi:Şubat 016)
- WHO. UNAIDS Report on the Global AIDS epidemic, 2010. Geneva. Accessible at: http://www.unaids.org/globalreport/Global_report.htm.
- World Health Organization, Unicef. Guidance on global scale-up of the prevention of mother to child transmission of HIV: towards universal access for women, infants and young children and eliminating HIV and AIDS among children / Inter-Agency Task Team on Prevention of HIV Infection in Pregnant Women, Mothers and their Children. WHO, 2007, Switzerland. Http://www.unicef.org/aids/fi les/PMTCT_enWEBNov26.pdf. (erişim tarihi:Şubat 2016).
- Mofenson L, Taylor AW, Rogers M. Achievements in public health. Reduction in perinatal transmission of HIV infection- United States, 1985-2005. MMWR Morb Mortal Wkly Rep. 2006;55:592-7.
- Sütçü M, Aktürk H, Somer A, Törün SH, İnce Z, Çoban A et al. Anneden bebeğe HIV geçişi: sekiz yıllık deneyim. Mikrobiyol Bul. 2015;49:542-53.
- Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States.Panel onTreatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission;2014. http://aidsinfo.nih.gov/guidelines/html/3/perinatal-guidelines/0/ (erişim tarihi: Şubat 2016).
- Gale HB, Gitterman SR, Hoffman HJ, Gordin FM, Benator DA, Labriola AM. Is frequent CD4+ T- lymphocyte count monitoring necessary for persons with counts >=300 cells/μL and HIV-1 suppression? Clin Infect Dis. 2013;56:1340-3.
- Cooper ER, Charurat M, Mofenson L, Hanson CI, Pitt J, Diaz C. Combination antiretroviral strategies for the treatment of pregnant HIV-1-infected women and prevention of perinatal HIV- 1 transmission. J Acquir Immune Defic Syndr. 2002:29:484-94.
- The International Perinatal HIV Group .The mode of delivery and the risk of vertical transmission of human immunodeficiency virus type 1--a meta-analysis of 15 prospective cohort studies. N Engl J Med. 1999;340:977-87.
- The National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America.Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: Recommendations from the Centers for Disease Control and Prevention.2015 http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf (erişim tarihi:Şubat 2016).
- Bonacini M, Lin HJ, Hollinger FB. Effect of coexisting HIV-1 infection on the diagnosis and evaluation of hepatitis C virus. J Acquir Immune Defic Syndr. 2001;26:340-4.
- Thio CL, Nolt KR, Astemborski J, Vlahov D, Nelson KE, Thomas DL. Screening for hepatitis C virus in human immunodeficiency virus-infected individuals. J Clin Microbiol. 2000;38:575-7.
- Mwapasa V, Rogerson SJ, Kwiek JJ, Wilson PE, Milner D, Molyneux ME. Maternal syphilis infection is associated with increased risk of mother-to-child transmission of HIV in Malawi. AIDS. 2006;20:1869-77.
- Tuomala RE, Watts DH, Li D, Vajaranant M, Pitt J, Hammill H. Improved obstetric outcomes and few maternal toxicities are associated with antiretroviral therapy, including highly active antiretroviral therapy during pregnancy. J Acquir Immune Defic Syndr. 2005;38:449-73.
- Pickering LK, Baker CJ, Freed GL, Gall SA, Grogg SE, Poland GA. Immunization programs for infants, children, adolescents, and adults: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2009;49:817-40.
- Ford N, Shubber Z, Jao J, Abrams EJ, Frigati L, Mofenson L. Safety of cotrimoxazole in pregnancy: a systematic review and meta-analysis. J Acquir Immune Defic Syndr. 2014;66:512-21.
- Floridia M, Ravizza M, Pinnetti C, Tibaldi C, Bucceri A, Anzidei G. Treatment change in pregnancy is a significant risk factor for detectable HIV-1 RNA in plasma at end of pregnancy. HIV Clin Trials. 2010;11:303-11.
- Antiretroviral Pregnancy Registry Steering Committee. Antiretroviral Pregnancy Registry International Interim Report for 1 January 1989 through 31 January 2015. Wilmington, NC: Registry Coordinating Center; 2015. www.APRegistry.com (erişim tarihi:Şubat 2016).
- Ekoukou D, Khuong-Josses MA, Ghibaudo N, Mechali D, Rotten D. Amniocentesis in pregnant HIV- infected patients. Absence of mother-to-child viral transmission in a series of selected patients. Eur J Obstet Gynecol Reprod Biol. 2008;140:212-7.
- Maiques V, García-Tejedor A, Perales A, Córdoba J, Esteban RJ. HIV detection in amniotic fluid samples. Amniocentesis can be performed in HIV pregnant women? Eur J Obstet Gynecol Reprod Biol. 2003;108:137-41.
- European Collaborative Study. Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy. Clin Infect Dis. 2005;40:458-65.
- Townsend CL, Cortina-Borja M, Peckham CS, de Ruiter A, Lyall H, Tookey PA. Low rates of mother- to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000-2006. AIDS. 2008;22:973-81.
- Cotter AM, Brookfield KF, Duthely LM, Gonzalez Quintero VH, Potter JE, O'Sullivan MJ . Duration of membrane rupture and risk of perinatal transmission of HIV-1 in the era of combination antiretroviral therapy. Am J Obstet Gynecol. 2012;207:482.e1-5.
- Briand N, Jasseron C, Sibiude J, Azria E, Pollet J, Hammou Y. Cesarean section for HIV-infected women in the combination antiretroviral therapies era, 2000-2010. Am J Obstet Gynecol. 2013;209:335.e1-12.
- European Mode of Delivery Collaboration. Elective caesarean-section versus vaginal delivery in prevention of vertical HIV-1 transmission: a randomised clinical trial. Lancet. 1999; 353:1035-9.
- Kourtis AP, Bulterys M, Nesheim SR, Lee FK . Understanding the timing of HIV transmission from mother to infant. JAMA. 2001;285:709-12
- American College of Obstetricians and Gynecologists. Committee Opinion No. 635. Prenatal and perinatal human immunodeficiency virus testing: expanded recommendations. Obstet Gynecol. 2015;125:1544–7.
- Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. August 06, 2015. http://aidsinfo.nih.gov/guidelines/html/3/perinatal-guidelines/0/ (erişim tarihi: Şubat 2016).
- Briand N, Warszawski J, Mandelbrot L, Dollfus C, Pannier E, Cravello Let al. Is intrapartum intravenous zidovudine for prevention of mother-to-child HIV-1 transmission still useful in the combination antiretroviral therapy era? Clin Infect Dis. 2013;57:903-14.
- Wong VV. Is peripartum zidovudine absolutely necessary for patients with a viral load less than 1,000 copies/ml? J Obstet Gynaecol. 2011;31:740-2.
- Nielsen-Saines K, Watts DH, Veloso VG, Bryson YJ, Joao EC, Pilotto JHet al. Three postpartum antiretroviral regimens to prevent intrapartum HIV infection. N Engl J Med. 2012;366:2368-79.
- John-Stewart GC. When is replacement feeding safe for infants of HIV-infected women? PLoS Med. 2007;4:e30.
- Connor EM, Sperling RS, Gelber R, Kiselev P, Scott G, O'Sullivan MJ et al. Reduction of maternal- infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. N Engl J Med. 1994; 331:1173-80.
- Moodley D, Pillay K, Naidoo K, Moodley J, Johnson MA, Moore KHet al. Pharmacokinetics of zidovudine and lamivudine in neonates following coadministration of oral doses every 12 hours. J Clin Pharmacol. 2001;41:732-41.
- Petra Study Team. Efficacy of three short-course regimens of zidovudine and lamivudine in preventing early and late transmission of HIV-1 from mother to child in Tanzania, South Africa, and Uganda (Petra study): a randomised, double-blind, placebo-controlled trial. Lancet. 2002;359:1178-86.
- Siberry GK, Williams PL, Mendez H, Seage GR 3rd, Jacobson DL, Hazra Ret al. Safety of tenofovir use during pregnancy: early growth outcomes in HIV-exposed uninfected infants. AIDS. 2012;26:1151-9.
- Siberry GK, Jacobson DL, Kalkwarf HJ, Wu JW, DiMeglio LA, Yogev Ret al. Lower Newborn Bone Mineral Content Associated With Maternal Use of Tenofovir Disoproxil Fumarate During Pregnancy. Clin Infect Dis. 2015;61:996-1003.
- Ford N, Mofenson L, Shubber Z, Calmy A, Andrieux-Meyer I, Vitoria M et al. Safety of efavirenz in the first trimester of pregnancy: an updated systematic review and meta-analysis. AIDS. 2014;28:123-31.
- Taylor N, Touzeau V, Geit M, Gisinger M, Egle A, Greil Ret al. Raltegravir in pregnancy: a case series presentation. Int J STD AIDS. 2011;22:358-60.
- Blonk MI, Colbers AP, Hidalgo-Tenorio C, Kabeya K, Weizsäcker K et al. Raltegravir in HIV-1- infected pregnant women: pharmacokinetics, safety, and efficacy. Clin Infect Dis. 2015;61:809- 16.
- McKeown DA, Rosenvinge M, Donaghy S, Sharland M, Holt DW, Cormack I et al. High neonatal concentrations of raltegravir following transplacental transfer in HIV-1 positive pregnant women. AIDS. 2010;24:2416-8.
- Westling K, Pettersson K, Kaldma A, Navér L. Rapid decline in HIV viral load when introducing raltegravir-containing antiretroviral treatment late in pregnancy. AIDS Patient Care STDS. 2012;26:714-7.
- Correspondence Address / Yazışma Adresi Mete Sucu
- Çukurova Üniversitesi Tıp Fakültesi
- Kadın Hastalıkları ve Doğum ABD Adana
- e-mail: metesucu@yahoo.com
- Geliş tarihi/ Received: 23.02.2016
- Kabul tarihi/Accepted: 04.04.2016