BackgroundBasic Epidemiology and Prevalence
In the United States, women account for a growingproportion of patients with human immunodeficiencyvirus (HIV) and acquired immunodeficiency syndrome(AIDS) (from 7% in 1985 to 27% in 2007) . Heterosexual contact is responsible for 72% of HIV transmission among women in the United States, and womenof color are disproportionately affected, accounting for80% of HIVinfected women . In most women withHIV, the infection is diagnosed during their reproductiveyears.
Antiretroviral Therapy for NonpregnantHIVinfected Women
Treatment of HIV and AIDS should be provided bya health care practitioner with expertise in HIV. Suchexpertise has been shown to be a factor that prolongs thelife of HIVinfected individuals . A team approach is optimal to address both the medical and socialcomplexity of HIV infection. In addition to obtaining acomprehensive medical history, including a gynecologichistory and an HIVrelated history, a detailed social history also should be obtained. Women with HIV oftenhave life circumstances, such as alcohol or drug addiction, psychiatric illness, and domestic violence, that requirespecial attention. Appropriate sensitivity is needed toaddress these life circumstances and to treat HIV.In nonpregnant adults, initiation of antiretroviraltherapy is recommended for patients with a history of anAIDSdefining illness (Box 1) or a CD4 Tcell (or CD4)count of less than 500 cells per cubic millimeter. Forpatients with CD4 counts of 500 cells per cubic millimeter or greater, antiretroviral therapy may be offered.Antiretroviral medications select for resistant mutationswhen used as monotherapy; therefore, combinations ofthree or more drugs, often called highly active antiretroviral therapy (HAART), are used and strict adherence tothe dose regimens is critical. There are currently morethan 20 U.S. Food and Drug Administration (FDA)not be used as a component of combination therapy inthis setting unless the benefits clearly outweigh the risks.Liver toxicity has not been seen in women undergoingsingledose nevirapine therapy during labor for prevention of perinatal transmission.
完整下載 2010ACOG臨床指南：產(chǎn)時胎兒心律監(jiān)護(hù)的管理