What is the role of opportunistic infection assessment in the management of pregnant women with HIV infection?

Updated: Apr 02, 2019
  • Author: Ashley T Peterson, MD; Chief Editor: Ronald M Ramus, MD  more...
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Answer

Answer

Evaluation of opportunistic infectious disease states should be performed in accordance with current guidelines. Assessment of the need for prophylaxis against Pneumocystis jiroveci pneumonia (PCP),Mycobacterium avium complex (MAC) infection, and reactivation toxoplasmosis is necessary based on CD4 counts. Though routine toxoplasmosis titers are not recommended for all pregnant women in the United States, baseline titers should be obtained for HIV-infected women and suppressive therapy is recommended in women with low CD4 counts and a positive IgG. For women with low CD4 counts, prophylaxis for PCP is with trimethoprim-sulfamethoxazole (TMP-SMX). Due to potential teratogenicity, aerosolized pentamidine may be substituted in the first trimester, as it is not absorbed systemically. Atovaquone administration is also an oral alternative to TMP-SMX in the first trimester. For prophylaxis of MAC, azithromycin is used in place of clarithromycin because of potential teratogenicity. Cytomegalovirus should not be routinely screened for in HIV-infected pregnant patients, however assessment for re-infection or reactivation of disease is the same as for non-pregnant HIV-infected individuals.


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