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December 2016

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December 2016

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December 2016

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December 2016

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December 2016

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Practice Bulletin Number 167, October 2016

(Replaces Practice Bulletin 117, December 2010, and Committee Opinion 572, September 2013)

In the United States in 2013, there were an estimated 226,000 women and adolescents living with human immunodeficiency virus (HIV) infection (1). Women with HIV are living longer, healthier lives, so the need for routine and problem-focused gynecologic care has increased. The purpose of this document is to educate clinicians about basic health screening and care, family planning, prepregnancy care, and managing common gynecologic problems for women and adolescents who are infected with HIV. For information on screening guidelines, refer to the American College of Obstetricians and Gynecologis...


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Committee Opinion Number 655, February 2016

ABSTRACT: To prevent transmission of bloodborne pathogens, it is important that health care providers adhere to standard precautions, follow fundamental infection-control principles, and use appropriate procedural techniques. All obstetrician–gynecologists who provide clinical care should receive the hepatitis B virus vaccine series. The Society for Healthcare Epidemiology of America has established guidelines for the management of health care providers who are infected with hepatitis B virus, hepatitis C virus, or human immunodeficiency virus (HIV). The guidelines categorize representative o...


Committee Opinion Number 635, June 2015

(Replaces Committee Opinion Number 418, September 2008, Reaffirmed 2016)

ABSTRACT: Given the enormous advances in the prevention of perinatal transmission of human immunodeficiency virus (HIV), it is clear that early identification and treatment of all pregnant women with HIV is the best way to prevent neonatal infection and also improve women’s health. Furthermore, new evidence suggests that early initiation of antiretroviral therapy in the course of infection is beneficial for individuals infected with HIV and reduces the rate of sexual transmission to partners who are not infected. Screening should be performed after women have been notified that HIV screening ...


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Statement of Policy (Reaffirmed July 2014), July 2014

The problem of perinatal transmission of HIV infection was first appreciated in 1982. In 1991, the Institute of Medicine (IOM) recommended a policy of routine counseling and offering testing (with specific informed consent) for HIV infection to all pregnant women. Since 1991, there have been major advances in the treatment of HIV infection, including demonstration in 1994 of the efficacy of zidovudine to reduce perinatal transmission. The U.S. Public Health Service subsequently issued guidelines for use of zidovudine to reduce perinatal transmission and for counseling and voluntary testing fo...


Committee Opinion Number 596, May 2014

(Replaces Committee Opinion Number 411, August 2008) (Reaffirmed 2016)

Abstract: Early diagnosis and treatment of human immunodeficiency virus (HIV) can improve survival and reduce morbidity. The Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists recommend that females aged 13–64 years be tested at least once in their lifetime and annually thereafter based on factors related to risk. In addition, obstetrician–gynecologists should annually review patients’ risk factors for HIV and assess the need for retesting. The opportunity for repeat testing should be made available to all women even in the absence of identi...


Committee Opinion Number 595, May 2014

(Reaffirmed 2016)

Abstract: Preexposure prophylaxis is defined as the administration of antiretroviral medications to individuals who are not infected with human immunodeficiency virus (HIV) and are at the highest risk of acquiring HIV infection. In combination with other proven HIV-prevention methods, preexposure prophylaxis may be a useful tool for women at the highest risk of HIV acquisition. Obstetrician–gynecologists involved in the care of women using preexposure prophylaxis must reinforce adherence to daily medication. The Centers for Disease Control and Prevention’s guidance for preexposure prophylaxis...


Committee Opinion Number 423, January 2009

Reaffirmed 2016

Abstract: Applying the principles of motivational interviewing to everyday patient interactions has been proved effective in eliciting "behavior change" that contributes to positive health outcomes and improved patient–physician communication. Current Procedural Terminology codes are available to aid in obtaining reimbursement for time spent engaging patients in motivational interviewing for some conditions.


18.
December 2007

Committee Opinion Number 389, December 2007

(Reaffirmed 2015)

ABSTRACT: Because human immunodeficiency virus (HIV) infection often is detected through prenatal and sexually transmitted disease testing, an obstetrician–gynecologist may be the first health professional to provide care for a woman infected with HIV. Universal testing with patient notification and right of refusal ("opt-out" testing) is recommended by most national organizations and federal agencies. Although opt-out and "opt-in" testing (but not mandatory testing) are both ethically acceptable, the former approach may identify more women who are eligible for therapy and may have public hea...


Committee Opinion Number 234, May 2000

(Replaces No. 219, August 1999, Reaffirmed 2017)

Prevention of transmission of the human immunodeficiency virus (HIV) from mother to fetus or newborn (vertical transmission) is a major goal in the care of pregnant women infected with HIV. An important advance in this regard was the demonstration that treatment of the mother with zidovudine (ZDV) during pregnancy and labor and of the neonate for the first 6 weeks after birth could reduce the transmission rate from 25% to 8% (1). Continuing research into vertical transmission of HIV suggests that a substantial number of cases occur as the result of fetal exposure to the virus during labor a...


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