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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  • Pregnant Women Living with HIV Who Have Previously Received Antiretroviral Treatment or Prophylaxis but Are Not Currently Receiving Any Antiretroviral Medications (Brief)

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 Previously Received Antiretroviral Treatment or Prophylaxis but Are Not Currently Receiving Any Antiretroviral Medications

Last Updated: December 7, 2018; Last Reviewed: December 7, 2018

Panel's Recommendations for Pregnant Women Living with HIV Who Have Previously Received Antiretroviral Treatment or Prophylaxis but Are Not Currently Receiving Any Antiretroviral Medications
Panel's Recommendations
  • Obtain an accurate history of all prior antiretroviral (ARV) regimens used for treatment of HIV disease or prevention of transmission, including virologic efficacy, the patient’s tolerance of the medications, results of prior resistance testing, and problems with adherence (AIII).
  • Choose and initiate a combination antiretroviral therapy (ART) regimen based on results of prior resistance testing, prior ARV use, concurrent medical conditions, and current recommendations for ART in pregnancy, avoiding drugs with potential known adverse effects for the mother or fetus/infant (see Table 7) (AII).
  • If HIV RNA is above the threshold for resistance testing (i.e., >500 to 1,000 copies/mL), ARV resistance testing should be performed prior to starting an ARV drug regimen (see Antiretroviral Drug Resistance and Resistance Testing in Pregnancy) (AIII).
  • In general, ART should be initiated prior to receiving results of current ARV resistance studies, because longer use of ART during pregnancy has been associated with reduced transmission rates to the infant compared to shorter treatment periods. ART should be modified based on the results of the resistance assay, if necessary (BIII).
  • If the ART regimen results in insufficient viral suppression, repeat resistance testing and assess other considerations, including adherence, food requirements, and drug interactions (AII).
  • Consider consulting with an HIV treatment specialist about the choice of ART regimen to initiate in women who previously received ARV drugs or to modify ART in those who are not fully suppressed (BIII).
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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