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 C Virus/HIV Coinfection

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

Panel's Recommendations Regarding HIV/Hepatitis C Virus Coinfection
Panel's Recommendations
  • All pregnant women with HIV should be screened during the current pregnancy for hepatitis C virus (HCV) infection unless they are known to have HCV/HIV coinfection (AIII).
    • HCV screening should be repeated later in pregnancy in women who initially screen negative for HCV but who have persistent or new risk factors for HCV (e.g., new or ongoing injection or intranasal substance use) (AIII).
    • All pregnant women with HIV should also be tested for hepatitis B virus (HBV) infection, unless they are known to have HBV/HIV coinfection or if they have serologic documentation of HBV immunity (see Hepatitis B Virus/HIV Coinfection).
  • Women with HCV infection who have not already received the hepatitis A virus (HAV) vaccine series should be screened for immunity to HAV (AIII). If they screen negative for HAV antibodies (IgG or IgG plus IgM), they should receive the HAV vaccine series (AIII).
  • All pregnant women with HIV and/or HCV who screen negative for HBV infection (i.e., HBV surface antigen negative, HBV core antibody negative, and HBV surface antibody negative) or who lack HBV immunity (i.e., HBV surface antibody negative) should receive the HBV vaccine series (AII).
  • Currently, treatment of HCV during pregnancy is not recommended due to the lack of safety data on the use of HCV direct-acting antiviral medications in pregnant women. When considering initiating HCV treatment in a pregnant woman with HIV coinfection, consultation with an expert in HIV and HCV is strongly recommended (AIII).
  • Recommendations for antiretroviral therapy (ART) during pregnancy are the same for all women living with HIV, whether they have HCV or not (AIII).
  • Pregnant women with HCV/HIV coinfection who are receiving ART should be counseled about the signs and symptoms of liver toxicity, and hepatic transaminases should be assessed 1 month following initiation of ART and at least every 3 months thereafter during pregnancy (BIII).
  • Decisions concerning the mode of infant delivery in pregnant women with HCV/HIV coinfection should be based on standard obstetric and HIV-related indications alone; HCV coinfection does not necessitate cesarean delivery when not otherwise indicated (see Transmission and Mode of Delivery) (AIII).
  • Infants born to women with HCV/HIV coinfection should be evaluated for HCV infection (AIII). Decisions regarding the specific type of assays to use for HCV screening in children and the timing of those assays should be made after consultation with an expert in pediatric HCV infection (AIII).
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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