Abstract：
OBJECTIVE: This guideline provides an update on the care of pregnant women living with HIV and the prevention of perinatal HIV transmission. This guideline is a revision of the previous guideline, No. 310 Guidelines for the Care of Pregnant Women Living With HIV and Interventions to Reduce Perinatal Transmission, and includes an updated review of the literature with contemporary recommendations.
METHODS: Pregnant women newly diagnosed with HIV during antenatal screening and women living with HIV who become pregnant. This guideline does not include specific guidance for girls/women of reproductive age living with HIV who are not pregnant.
RESULTS: Prevention of perinatal HIV transmission is a key indicator of the success of a health care system and requires multidisciplinary care of pregnant women living with HIV. Intended outcomes include guidance on best practice in perinatal management for Canadian health care providers for pregnant women living with HIV; reduction of perinatal transmission of HIV toward a target of eradication of perinatal transmission; provision of optimal antenatal care for pregnant women to ensure the best maternal health outcomes and HIV suppression; and evidence-based support and recommendations for pregnant women living with HIV, maintaining awareness and consideration of the complex psychosocial impacts of living with HIV.
RESULTS: The perinatal transmission of HIV has significant morbidity and mortality implications for the child, with associated lifelong health care costs. Pregnancy presents an emotionally and physically vulnerable time for pregnant women as well as an opportunity to engage them in health promotion. This guidance does not include recommendations with additional costs to health care facilities compared with the previous guideline. Application of the recommendations is aimed at health benefits to both mother and child by optimizing maternal health and preventing perinatal HIV transmission.
METHODS: Published and unpublished literature was reviewed with a focus on publications post-2013. OVID-Medline, Embase, PubMed and the Cochrane Library databases were searched for relevant publications available in English or French for each section of this guideline. Results included systematic reviews, randomized controlled trials, and observational studies published from 2012 to 2022. Searches were updated on a regular basis and incorporated in the guideline until May 2023. Unpublished literature, protocols, and international guidelines were identified by accessing the websites of health-related agencies, clinical practice guideline collections, and national and international medical specialty societies.
METHODS: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional recommendations).
UNASSIGNED: The intended users of this guideline include obstetric care providers and infectious disease clinicians who provide care for pregnant women living with HIV.
UNASSIGNED: Updated Canadian HIV in pregnancy guideline informed by global research and tailored to Canadian healthcare needs and goals for pregnant women living with HIV and their families.
CONCLUSIONS: RECOMMENDATIONS.
METHODS: Pregnant women newly diagnosed with HIV during antenatal screening and women living with HIV who become pregnant. This guideline does not include specific guidance for girls/women of reproductive age living with HIV who are not pregnant.
RESULTS: Prevention of perinatal HIV transmission is a key indicator of the success of a health care system and requires multidisciplinary care of pregnant women living with HIV. Intended outcomes include guidance on best practice in perinatal management for Canadian health care providers for pregnant women living with HIV; reduction of perinatal transmission of HIV toward a target of eradication of perinatal transmission; provision of optimal antenatal care for pregnant women to ensure the best maternal health outcomes and HIV suppression; and evidence-based support and recommendations for pregnant women living with HIV, maintaining awareness and consideration of the complex psychosocial impacts of living with HIV.
RESULTS: The perinatal transmission of HIV has significant morbidity and mortality implications for the child, with associated lifelong health care costs. Pregnancy presents an emotionally and physically vulnerable time for pregnant women as well as an opportunity to engage them in health promotion. This guidance does not include recommendations with additional costs to health care facilities compared with the previous guideline. Application of the recommendations is aimed at health benefits to both mother and child by optimizing maternal health and preventing perinatal HIV transmission.
METHODS: Published and unpublished literature was reviewed with a focus on publications post-2013. OVID-Medline, Embase, PubMed and the Cochrane Library databases were searched for relevant publications available in English or French for each section of this guideline. Results included systematic reviews, randomized controlled trials, and observational studies published from 2012 to 2022. Searches were updated on a regular basis and incorporated in the guideline until May 2023. Unpublished literature, protocols, and international guidelines were identified by accessing the websites of health-related agencies, clinical practice guideline collections, and national and international medical specialty societies.
METHODS: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional recommendations).
UNASSIGNED: The intended users of this guideline include obstetric care providers and infectious disease clinicians who provide care for pregnant women living with HIV.
UNASSIGNED: Updated Canadian HIV in pregnancy guideline informed by global research and tailored to Canadian healthcare needs and goals for pregnant women living with HIV and their families.
CONCLUSIONS: RECOMMENDATIONS.
摘要：
目的：本指南提供了对感染艾滋病毒的孕妇的护理和预防围产期艾滋病毒传播的最新信息。本准则是对先前准则的修订，不。310感染艾滋病毒的孕妇护理指南和减少围产期传播的干预措施，并包括对具有当代建议的文献的最新评论。
方法：在产前筛查期间新诊断为HIV的孕妇和感染HIV的孕妇怀孕。该准则不包括对未怀孕的育龄期感染艾滋病毒的女孩/妇女的具体指导。
结果：预防围产期艾滋病毒传播是卫生保健系统成功的关键指标，需要对感染艾滋病毒的孕妇进行多学科护理。预期成果包括指导加拿大保健提供者为感染艾滋病毒的孕妇提供围产期管理的最佳做法；减少艾滋病毒的围产期传播，以达到根除围产期传播的目标；为孕妇提供最佳的产前护理，以确保最佳的孕产妇健康结果和艾滋病毒抑制；以及为感染艾滋病毒的孕妇提供基于证据的支持和建议，保持对艾滋病毒感染者复杂的社会心理影响的认识和考虑。
结果：艾滋病毒的围产期传播对儿童具有显著的发病率和死亡率影响，与相关的终身医疗保健费用。怀孕为孕妇提供了情感和身体上脆弱的时间，也是让她们参与健康促进的机会。与以前的指南相比，本指南不包括医疗设施额外费用的建议。这些建议的应用旨在通过优化孕产妇健康和防止围产期艾滋病毒传播来对母婴健康有益。
方法：回顾了已发表和未发表的文献，重点关注2013年后的出版物。OVID-Medline,Embase,在PubMed和CochraneLibrary数据库中搜索本指南各部分的英文或法文相关出版物。结果包括系统评价，随机对照试验，以及2012年至2022年发表的观察性研究。搜索会定期更新，并在2023年5月之前纳入指南。未发表的文献，协议,并通过访问卫生相关机构的网站确定了国际准则，临床实践指南收集，以及国家和国际医学专业协会。
方法：作者使用建议分级评估对证据质量和建议强度进行了评估，开发和评估(等级)方法。见附录A(表A1定义和A2解释强和有条件的建议)。
■本指南的预期使用者包括为感染艾滋病毒的孕妇提供护理的产科护理提供者和传染病临床医生。
■更新了加拿大艾滋病毒怀孕指南，并根据加拿大的医疗保健需求和目标，为感染艾滋病毒的孕妇及其家人量身定制。
方法：在产前筛查期间新诊断为HIV的孕妇和感染HIV的孕妇怀孕。该准则不包括对未怀孕的育龄期感染艾滋病毒的女孩/妇女的具体指导。
结果：预防围产期艾滋病毒传播是卫生保健系统成功的关键指标，需要对感染艾滋病毒的孕妇进行多学科护理。预期成果包括指导加拿大保健提供者为感染艾滋病毒的孕妇提供围产期管理的最佳做法；减少艾滋病毒的围产期传播，以达到根除围产期传播的目标；为孕妇提供最佳的产前护理，以确保最佳的孕产妇健康结果和艾滋病毒抑制；以及为感染艾滋病毒的孕妇提供基于证据的支持和建议，保持对艾滋病毒感染者复杂的社会心理影响的认识和考虑。
结果：艾滋病毒的围产期传播对儿童具有显著的发病率和死亡率影响，与相关的终身医疗保健费用。怀孕为孕妇提供了情感和身体上脆弱的时间，也是让她们参与健康促进的机会。与以前的指南相比，本指南不包括医疗设施额外费用的建议。这些建议的应用旨在通过优化孕产妇健康和防止围产期艾滋病毒传播来对母婴健康有益。
方法：回顾了已发表和未发表的文献，重点关注2013年后的出版物。OVID-Medline,Embase,在PubMed和CochraneLibrary数据库中搜索本指南各部分的英文或法文相关出版物。结果包括系统评价，随机对照试验，以及2012年至2022年发表的观察性研究。搜索会定期更新，并在2023年5月之前纳入指南。未发表的文献，协议,并通过访问卫生相关机构的网站确定了国际准则，临床实践指南收集，以及国家和国际医学专业协会。
方法：作者使用建议分级评估对证据质量和建议强度进行了评估，开发和评估(等级)方法。见附录A(表A1定义和A2解释强和有条件的建议)。
■本指南的预期使用者包括为感染艾滋病毒的孕妇提供护理的产科护理提供者和传染病临床医生。
■更新了加拿大艾滋病毒怀孕指南，并根据加拿大的医疗保健需求和目标，为感染艾滋病毒的孕妇及其家人量身定制。
