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JAC Advance Access originally published online on August 25, 2009
Journal of Antimicrobial Chemotherapy 2009 64(5):895-900; doi:10.1093/jac/dkp303
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Leading articles

The safety of highly active antiretroviral therapy for the HIV-positive pregnant mother and her baby: is ‘the more the merrier’?

F. Martin* and G. P. Taylor

Section of Infectious Diseases, Faculty of Medicine, Imperial College, Norfolk Place, London W2 1PG, UK

* Corresponding author. Tel/Fax: +44-207594-3910; E-mail: f.martin{at}imperial.ac.uk

Highly active antiretroviral therapy (HAART) is frequently indicated for pregnant women both for maternal health and for prevention of mother-to-child HIV transmission, which can be reduced to <1%. Prospective data and large cohort studies have not found any evidence that antiretroviral therapy significantly increases the risk of congenital malformation. Nucleoside analogue reverse transcriptase inhibitors (NRTIs) are, to varying degrees, toxic to mitochondria, and molecular and clinical evidence of mitochondrial toxicity has been reported, albeit rarely, in NRTI-exposed but HIV-uninfected children. However, with NRTI-based fully suppressive antiretroviral therapy this effect was not seen. Although conflicting observational data have been reported, an increased risk of pre-term delivery with HAART compared with zidovudine monotherapy remains a concern.

Keywords: HAART , vertical transmission , pre-term delivery


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