| I On the basis of at least one randomized study with clinical end points * | II On the basis of surrogate marker studies | III According to expert opinion |
---|---|---|---|
A Unambiguous recommendation | A I | A II | A III |
B In general advisable | B I | B II | B III |
C Justifiable | C I | C II | C III |
D In general not recommended | D I | D II | D III |
E Unambiguously not recommended | E I | E II | E III |
Table 1(Additional). Diagnostic measures during a uncomplicated HIV1 pregnancy | |||
Diagnostic measure | Timepoint/frequency | Reason | Â |
HIV-screening and if necessary HIV-confirmative test | -routinely in the 1st trimester in case of unknown HIV1-status; -at the start of the 3rd trimester after negative initial test but continuous risk of infection | Precondition for therapeutic measures to reduce the risk of vertical HIV1-transmission | Â |
CD4 cell count + viral-load | At least every two months | Monitoring the course of the HIV1-infection; Initiation of ART or switchover of ART in case of therapeutic failure Control of the efficacy of the (HA)ART to prevent a high HIV1-viral load at birth | Â |
HIV1-resistance test | 1. As early as possible before the onset of prophylaxis 2. In case of virological therapy failure during an ART 3. With detectable viral load towards the end of an HIV1-prophylaxis 4. 2-6 weeks after application of a prepartal NVP ultra-short prophylaxis | 1. Exclusion of a primary ZDV resistance [38–41] 2. According to general therapeutic recommendations for optimizing a therapeutic switchover [29] 3. Registration of any possible resistance induction that might have implications for a future therapy [42] 4. Documentation of a potential resistance induction [43, 44] |  |
Blood count (Hemoglobin value) | Monthly | Detection of anemia, thrombopenia related to the use of ZDV in particular | Â |
Oral glucose tolerance test | Between 23rd (+0) and 27th (+6) weeks of gestation | Detection of gestation diabetes | Â |
Lactate level + liver values + γGT + LDH + lipase | 1. At the start of pregnancy 2. After onset of therapy/prophylaxis 3. In case of clinical symptoms 4. Monthly in the third Trimester | Recommended for detecting lactic acidosis (raised incidence in the 3rd trimester). Discussion of raised lactate and other values in cooperation with clinicians experienced in carrying out and analyzing lactate measurements. |  |
pH measurement in the vaginal secretion Native preparation Microbiological culture STD-diagnostics: Chlamydia, gonorrhea, trichomonas, syphilis hepatitis serology | Â | Recognition and timely treatment of local co-infections that can increase the risk of HIV1-transmission | Â |
Toxoplasmosis screening | At the start of a pregnancy as well as in the 2nd and 3rd trimesters | For the diagnosis of a new infection or a toxoplasmosis reactivation | Â |
Colposcopy, cytological controls for vulvar, vaginal and cervical dysplasias, HPV-testing | Colposcopy, cytological examination and HPV-testing at the start of a pregnancy; If abnormalities are revealed, colposcopic controls and wherever necessary histological clarification (biopsy) | Increased risk of dysplasia with HIV1-infection [37] | Â |
Measurement nuchal translucency | 10th (+6) - 13th (+6) week of gestation | Estimation of the risk of aneuploidy | Â |
Sonography, at least DEGUM stage 2 | 19th (+6) - 22nd (+6) week of gestation | Exclusion of malformations | Â |