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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Special Populations

Hepatitis B Virus/HIV Coinfection

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

Panel's Recommendations Regarding HIV/Hepatitis B Virus Coinfection
Panel's Recommendations
  • All pregnant women living with HIV should be screened during the current pregnancy for
    1. Hepatitis B virus (HBV) infection, unless they are known to have HBV/HIV coinfection or serologic documentation of HBV immunity, and
    2. Hepatitis C virus (HCV) infection, unless they are already known to have HCV/HIV coinfection (see Hepatitis C Virus/HIV Coinfection) (AIII).
  • All pregnant women living with HIV who screen negative for HBV (i.e., HBV surface antigen negative, HBV core antibody negative, and HBV surface antibody negative) should receive the HBV vaccine series (AII).
  • Women with chronic HBV infection who have not already received the hepatitis A virus (HAV) vaccine series should be screened for immunity to HAV. If they screen negative for HAV immunoglobulin G antibody, they should receive the HAV vaccine series (AIII).
  • All pregnant and postpartum women with HBV/HIV coinfection should receive antiretroviral therapy (ART). Antepartum ART in pregnant women with HBV/HIV coinfection should include tenofovir disoproxil fumarate (TDF) plus lamivudine or emtricitabine (AI). If a woman with HBV/HIV coinfection becomes pregnant while virally suppressed on an antiretroviral (ARV) regimen that includes tenofovir alafenamide (TAF) plus lamivudine or emtricitabine, she can be offered the choice of continuing that ART regimen or switching TAF to TDF in her ART regimen (BIII).
  • Pregnant women with HBV/HIV coinfection who are receiving ARV drugs should be counseled about signs and symptoms of liver toxicity, and liver transaminases should be assessed 1 month following initiation of ART and at least every 3 months thereafter during pregnancy (BIII).
  • Women with chronic HBV should be counseled on the importance of continuing anti-HBV medications indefinitely, both during and after pregnancy. If ARV drugs that include anti-HBV activity are discontinued in women with HBV/HIV coinfection, frequent monitoring of liver function tests for potential exacerbation of HBV infection is recommended, with prompt re-initiation of treatment for HBV when a flare is suspected (BIII).
  • Decisions concerning mode of delivery of the infant in a pregnant woman with HBV/HIV coinfection should be based on standard obstetric and HIV-related indications alone; HBV/HIV coinfection does not necessitate a cesarean delivery if not otherwise indicated (see Transmission and Mode of Delivery) (AIII).
  • Within 12 hours of birth, infants born to women with HBV infection should receive hepatitis B immune globulin and the first dose of the HBV vaccine series (AI).
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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