Table of Contents

• Section I
• Section II
  

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Recommendations for HIV Infected Pregnant Women

1.  HIV infected pregnant women should receive counseling as previously recommended in the CDC, 1994 document "HIV Counseling, Testing and Referral: Standards & Guidelines from the U.S. Department of Health & Human Services". Post test HIV counseling should include an explanation of the clinical implications of a positive HIV antibody test result and the need for, benefit of, and means to access HIV related medical and other early intervention services. Such counseling should also include a discussion of the interaction between pregnancy and HIV infection, the risk for perinatal HIV transmission and ways to reduce this risk, the prognosis for infants who become infected, and available existing support services and reasonable linkages with those services.

2. HIV infected pregnant women should be evaluated according to published recommendations to assess their need for antiretroviral therapy, antimicrobial prophylaxis, and treatment of other conditions. Although medical management of HIV infection is essentially the same for pregnant and non-pregnant women, recommendations for treating a patient who has tuberculosis have been modified for pregnant women because of potential teratogenic effects of specific medications (e.g., streptomycin and pyrazinamide). HIV infected pregnant women should be evaluated to determine their need for psychological and social services, and referrals made as appropriate. All providers including managed care providers should ensure that support services are available to women.

3. HIV infected pregnant women should be provided information concerning ZDV and current accepted drug therapy to reduce the risk for perinatal HIV transmission. This information should address the potential benefit and short-term safety of ZDV and the uncertainties regarding:

a. long-term risks of such therapy, and

b. effectiveness in women who have different clinical characteristics (e.g., CD4+ T-lymphocyte count and previous ZDV use) than women who participated in the trial.

HIV infected pregnant women should be encouraged, but not coerced, into taking ZDV therapy.  Decisions should be made after consideration of both the benefits and potential risks of the regimen to the woman and her child. Therapy should be offered according to the appropriate regimen in published recommendations. A woman's decision not to accept treatment should not result in punitive action or denial of care.

4. HIV infected pregnant women should receive information about all reproductive options. Health care providers should be aware of the complex issues that HIV infected women must consider when making decisions about their reproductive options, and reproductive counseling should be non-directive.

5. To reduce the risk for HIV transmission to their infants, HIV infected women should be advised against breast feeding. Support services should be provided when necessary for use of appropriate breastmilk substitutes (including available supplemental food programs).

6. Confidential HIV related information should be disclosed or shared only in accordance with Michigan law. To optimize medical management and comply with current law, counseling and testing acceptance or refusal should be documented. Positive or negative HIV test results should be available to a woman's health care provider and included on both her and her infant's confidential medical records. Providers should obtain from the mother a written release of information, specific for HIV-related information, which includes to whom, for what purposes, and for how long information will be released. After consulting with the mother, maternal health care providers should notify the pediatric care providers of the impending birth of an HIV exposed child, any anticipated complications, and whether ZDV should be administered after birth. If HIV is first diagnosed in the child, the child's health care providers should discuss the implication of the child's diagnosis for the woman's health and assist the mother in obtaining care for herself.

7. Counseling for HIV infected pregnant women should include an assessment of the potential for negative effects resulting from HIV infection (e.g., discrimination, domestic violence, and psychological difficulties). For women who anticipate or experience such effects, counseling also should include:

a) information on how to minimize these potential consequences,

b) assistance in identifying supportive persons within their own social network, and

c) referral to appropriate psychological, social, and legal services.

In addition, HIV infected women should be informed that discrimination against persons who are HIV infected, in matters such as housing, employment, state programs, and public accommodations (including physicians' offices and hospitals) is illegal.

8. HIV infected women should be encouraged to allow HIV testing of any of their children born after they became infected or after 1977 if they do not know when they became infected. Testing of older children should be done with the child's informed consent or assent. Women should be informed that the lack of signs and symptoms suggestive of HIV infection in older children does not necessarily indicate a lack of HIV infection; some perinatally infected children can remain asymptomatic for many years.

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