_______________________________________________________________________ HIV/AIDS: An Update
Considerations for Antiretroviral Therapy in HIV- Infected Pregnant Individuals HIV counseling and the offer of HIV testing to pregnant per- sons have been universally recommended in the United States and are now mandatory in some states. A pregnancy test should be performed for those with childbearing potential before initiating ART. Care of the HIV-infected pregnant individuals should involve collaboration between the HIV specialist caring for the patient when they are not pregnant, an obstetrician, and the patient. Treatment recommendations for HIV-infected pregnant patients are based on the belief that therapies of known benefit should not be withheld during pregnancy unless there are known adverse effects on the mother, fetus, or infant that outweigh the potential benefit. When selecting ART for a pregnant individual, clinicians should consider available safety and efficacy data on the use of each agent during pregnancy. The risks and benefits of ART during pregnancy should be discussed with all individuals of child-bearing potential, and clinicians should consult the most recent perinatal guidelines when designing a regimen [24; 35]. Initiation of ART is recommended for pregnant patients with HIV in all stages of pregnancy. Regardless of the stage of preg- nancy or childbirth, if a patient is found to be HIV-positive, there are treatment options that should be explored [24]. Patients should be registered with the Antiretroviral Pregnancy Registry, which collects observational, nonexperimental data. The registry is sponsored by GlaxoSmithKline, in affiliation with the CDC and Kendle International, Inc. Those who have been treated with ART at any time during their pregnancies are eligible for registry enrollment. Additional information and registration are available at https://www.apregistry.com [24; 56]. INFANTS AND CHILDREN WITH HIV In the United States today, the predominant route of infection with HIV in children is perinatal (from an infected pregnant woman to her fetus or infant). Thus, the epidemic in children is closely linked to the epidemic in women [23]. Clinical Symptoms in Children with HIV Infection Children with HIV/AIDS may have more than one infection at the same time or in succession (multiple opportunistic infections). Conditions associated with HIV infection in children are [25]: • Serious bacterial infections, multiple or recurrent (only among children younger than six years of age) • Candidiasis (esophageal or pulmonary) • COVID-19 • Cryptosporidiosis or isosporiasis with diarrhea persisting longer than one month • CMV disease • Disseminated coccidioidomycosis
• Extrapulmonary cryptococcosis • Encephalopathy • Giardiasis
• Hepatitis B virus • Hepatitis C virus • Herpes simplex virus infection causing bronchitis, pneumonitis, or esophagitis or causing a mucocutaneous ulcer that persists for longer than one month • Disseminated or extrapulmonary histoplasmosis • Human papillomavirus • Kaposi sarcoma • Lymphoma • Malaria • Microsporidiosis • Mpox • Disseminated or extrapulmonary Mycobacterium tuberculosis • Disseminated Mycobacterium avium or kansasii • PCP • Syphilis • Toxoplasmosis • VZV • Wasting syndrome Antiretroviral Treatment in Children As with adults, ART is believed to play a major role in slow- ing progression of HIV in children and adolescents. Children receiving ART should be monitored for side effects, adher- ence, efficacy and toxicity. Recommendations for initial antiretroviral therapy of HIV infection in children have been updated based on FDA approvals and new data; clinicians should consult HHS Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection when making management decisions for pediatric HIV care [23]. Following initiation of ART, all pediatric patients should be evaluated within one to two weeks to monitor compliance, side effects, and response to treatment. Subsequent visits should be scheduled every three to four months [23]. Strategies to improve adherence should focus on selecting an appropriate regimen, educating the family/caregiver, and consistent follow-up. OLDER PEOPLE WITH HIV In 2024, approximately 41% of individuals living with HIV were 55 years of age or older [26]. In the early years of the AIDS epidemic, little attention was given to older people with HIV, and HIV/AIDS was thought to be the disease of the young. As a result, prevention and education campaigns were tradition- ally not targeted toward older adults. However, effective ART and an emphasis on HIV research in older adults now allows
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MDCT2026
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