Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States

The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.

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Preconception Counseling and Care for Women of Childbearing Age Living with HIV

Reproductive Options for Couples When One or Both Partners are Living with HIV

Last Updated: December 24, 2019; Last Reviewed: December 24, 2019

Panel's Recommendations Regarding Reproductive Options for Couples When One or Both Partners are Living with HIV
Panel's Recommendations

For Couples Who Want to Conceive When One or Both Partners are Living with HIV:

  • Expert consultation is recommended to tailor guidance to couples’ specific needs (AIII).
  • Both partners should be screened and treated for genital tract infections before attempting to conceive (AII).
  • Partners with HIV should achieve sustained viral suppression (e.g., two recorded measurements of plasma viral loads that are below the limits of detection at least 3 months apart) before attempting conception to maximize their health, prevent HIV sexual transmission (AI) and, for pregnant persons with HIV, to minimize the risk of HIV transmission to the infant (AI).
  • For couples with differing HIV statuses, sexual intercourse without a condom allows for conception with effectively no risk of sexual HIV transmission to the partner without HIV when the partner with HIV is on antiretroviral therapy (ART) and has achieved sustained viral suppression (BII).
  • Additional guidance may be required in the following scenarios:
    • The partner with HIV has not achieved sustained viral suppression or the partner’s HIV viral suppression status is unknown,
    • There are concerns that the partner with HIV may be inconsistently adherent to ART during the periconception period, or
    • The provider needs to share additional information with the patient regarding options to prevent sexual HIV transmission during the periconception period.
  • In these circumstances, providers may choose to counsel their patient about the following options:
    • Administration of antiretroviral pre-exposure prophylaxis (PrEP) to the partner without HIV is recommended to reduce the risk of sexual acquisition of HIV (AI). Timing condomless sex to coincide with ovulation (peak fertility) is an approach that can optimize the probability of conception (AIII).
    • Even within couples with differing HIV statuses who attempt conception when the partner with HIV has achieved viral suppression, some partners without HIV may still choose to take PrEP (CIII).
Rating of Recommendations: A = Strong; B = Moderate; C = Optional

Rating of Evidence: I = One or more randomized trials with clinical outcomes and/or validated laboratory endpoints; II = One or more well-designed, nonrandomized trials or observational cohort studies with long-term clinical outcomes; III = Expert opinion

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