Table 1 Grading of the therapeutic recommendations
|
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 | |
|
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 | |
| 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 | |
| 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 | |
| Oral glucose tolerance test | Between 23rd (+0) and 27th (+6) weeks of gestation | Detection of gestation diabetes | |
| 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 | Recognition and timely treatment of local co-infections that can increase the risk of HIV1-transmission | ||
| 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 | |
| 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] | |
| Measurement nuchal translucency | 10th (+6) - 13th (+6) week of gestation | Estimation of the risk of aneuploidy | |
| Sonography, at least DEGUM stage 2 | 19th (+6) - 22nd (+6) week of gestation | Exclusion of malformations | |