Guidelines

Screening

All pregnant women should be offered HIV screening at booking visit (8-12 weeks).

Management

Antepartum Management

Antiretroviral Therapy (ART)

ALL women on an effective ART regimen who get pregnant should continue their ART treatment​​​​​​.

If the patient not on ART → should start ART as soon as possible (by 24 weeks the very latest)

• 1st choice regimen: tenofovir DX/emtricitabine + dolutegravir (if no renal or bone concerns)

Monitoring

• CD4 count at baseline + each trimester + at delivery
• Viral load 2-4 weeks after starting ART + every trimester + at 36 weeks + at delivery
• LFTs with routine blood

Intrapartum Management

Measure plasma viral load at 36 weeks and use that measurement to decide the mode of delivery.

• If viral load <50 copies/mL → vaginal delivery can be supported

• If viral load >50 copies/mL →
  • Planned (pre-labour) caesarean section to be considered from 38 weeks 
  • Zidovudine infusion throughout labour and/or delivery until cord clamping
    • Should be commenced 4 hours prior to planned Caesarean section

Postpartum Management

Mother

Continue lifelong ART postpartum

Baby

PNP to be started ASAP, latest within 4 hours.

Choice of PNP depends on the risk of acquiring HIV, low-risk features:

• All viral load measurements 10 weeks prior delivery are <50 copies/mL
• Maternal ART commenced at least 10 weeks prior delivery
• At least 1 viral load measurement 6 weeks prior delivery
• Good engagement from mother's end

Low Risk Baby (all the above met)

Offer zidovudine monotherapy for 2 weeks

High Risk Baby (any of the above not met) (esp. viral load >50 copies/mL)

Offer triple therapy PNP 

• Nevirapine for 2 weeks
• Zidovudine + lamivudine for 4 weeks

Breastfeeding

All women should be advised NOT to breastfeed.

Exclusive formula feeding is recommended.

References

Original Guideline