Materials in this section address treatment guidelines and access to antiretroviral drugs, as well as treatment as it relates to consent for health care, sex work, minors, women, and international issues. Treatment for HIV infection has evolved considerably since the first treatments were developed in the 1980s, as evidenced by the numerous iterations of the HIV treatment guidelines for adults, adolescents, children, and pregnant women issued by various agencies within the U.S. government. Treatment now usually takes the form of highly active antiretroviral therapy (HAART), which involves a combination of two or more different classes of anti-HIV drugs. For many people living with HIV, these treatments have enabled them to live longer, although not without debilitating side effects. For some, especially those living in under-resourced parts of the United Stated and the world, access to treatment remains a challenge. Underlying the conversations about the various benefits of HIV treatment are assumptions about what is best for certain individuals, particularly pregnant women and newborn infants, often without any discussion of the relative risks associated with the treatment. As a result, treatment without consent for pregnant women and newborn infants is not unheard of, thus increasing mistrust of the health care system and leading to missed opportunities for prevention efforts. In addition, treatment plays a role in other issues, such as criminal laws prohibiting HIV exposure, where treatment affects viral load, thus influencing the risk of transmission in a given situation.
Recommendations for Use of Antiretroviral Drugs in Pregnant Women Infected with HIV-1 for Maternal Health and for Reducing Perinatal HIV-1 Transmission in the U.S.
The recommendations review the special considerations regarding use of antiretroviral drugs for pregnant women, provide new information regarding the use of Viracept, update the results of PACTG 076 and related clinical trials and epidemiologic studies, discuss the use of HIV-1 RNA and antiretroviral drug resistance assays during pregnancy, provide updated recommendations on antiretroviral chemoprophylaxis for reducing perinatal transmission, and provide recommendations related to use of elective cesarean delivery to reduce transmission risk. The guidelines address issues such as evidence of toxicities connected with certain antiretroviral drugs, the importance of information and counseling to pregnant women, various clinical scenarios and appropriate clinical responses, the significance and prevalence of drug resistance, different transmission risks associated with different modes of delivery, recommendations for perinatal and long-term follow-up of HIV-positive women and their infants, and the need for clinical research on factors such as drug safety, drug resistance, stopping antiretroviral therapy, and the use of rapid testing at delivery. Click here to download.
General information about HIV treatment and care.
HIV InSite, University of California, San Francisco
Information on HIV medications, medication management, and treatment guidelines.
Information on HIV medications, making decisions about therapies, HIV-related conditions, and information specific to women with HIV.
Centers for Disease Control and Prevention (CDC)
Information related to HIV treatment guidelines, clinical trials, medications, treatment evaluation, and telephone hotlines.
New Jersey Division of Youth and Family Services v. L.V., 889 A.2d 1153 (N.J. Super. Ct. Ch. Div. 2005)
This opinion holds that an HIV-positive mother’s refusal during pregnancy to take antiretroviral medication (ARVs) to reduce the risk of transferring HIV to her fetus does not constitute an act of neglect or abuse under New Jersey law. This case demonstrates the substantial rights pregnant women have to determine the course of their medical treatment and the complexities involved in mandating ARV treatment. While L.V. is not dispositive in other jurisdictions, it is persuasive, especially given the lack of case law on ARV administration during pregnancy. Click here to download.