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

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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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Recommendations for Use of Antiretroviral Drugs During Pregnancy

Pregnant Women Living with HIV Who Have Never Received Antiretroviral Drugs (Antiretroviral Naive)

Last Updated: December 12, 2019; Last Reviewed: December 12, 2019

Panel's Recommendations for Pregnant Women Living with HIV Who Have Never Received Antiretroviral Drugs
Panel's Recommendations
  • Antiretroviral therapy (ART) is recommended for all pregnant women living with HIV to reduce the risk of perinatal transmission of HIV and to optimize the health of the mother (AI). Initiating ART as soon as possible in pregnant women who have never received antiretroviral (ARV) drugs is recommended, based on data demonstrating that earlier virologic suppression is associated with a lower risk of transmission (AII).
  • The results of HIV drug-resistance studies should guide the selection of antiretroviral (ARV) regimens in women whose HIV RNA levels are above the threshold for resistance testing (i.e., >500 copies/mL to 1,000 copies/mL), unless drug-resistance studies have already been performed (see Antiretroviral Drug Resistance and Resistance Testing in Pregnancy) (AII). When ART is initiated before the results of the drug-resistance assays are available, the ARV regimen should be modified, if necessary, based on the resistance assay results (BIII).
  • ARV regimens that are Preferred for the treatment of pregnant women with HIV who are ARV-naive include: a dual-nucleoside reverse transcriptase inhibitor combination (abacavir plus lamivudine or tenofovir disoproxil fumarate plus either emtricitabine or lamivudine) and either a ritonavir-boosted protease inhibitor (atazanavir/ritonavir or darunavir/ritonavir) or an integrase strand transfer inhibitor (dolutegravir [irrespective of trimester] or raltegravir; see Table 6 and Updated Guidance about the Use of Dolutegravir in Pregnancy in Recommendations for the Use of Antiretroviral Drugs During Pregnancy) (AIII).
  • The Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission emphasizes the importance of counseling and informed decision-making with regard to all ARV regimens for people living with HIV (AIII). See Appendix D: Dolutegravir Counseling Guide for Health Care Providers for more information.
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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