HIV-2 Infection and Pregnancy
Last Updated: December 12, 2019; Last Reviewed: December 12, 2019
Panel's Recommendations Regarding HIV-2 Infection and Pregnancy
- HIV-2 infection should be considered in pregnant women who are from—or who have partners who are from—countries in which the disease is endemic and who have positive results on an HIV-1/HIV-2 antibody or HIV-1/HIV-2 antigen/antibody immunoassay. They should be tested with a supplemental HIV-1/HIV-2 antibody differentiation assay. If they have only HIV-2 infection, the test will be negative for HIV-1 antibodies and positive for HIV-2 antibodies (AII).
- Pregnant women living with HIV-2 should be treated as per guidelines for HIV-1 mono-infection but using antiretroviral drugs that are active against HIV-2. Non-nucleoside reverse transcriptase inhibitors and enfuvirtide are not active against HIV-2 and should not be used (AIII).
- No randomized clinical trials have been performed to address when to start treatment or what the optimal treatment is for HIV-2 infection (AIII). A regimen with two nucleoside reverse transcriptase inhibitors and integrase strand transfer inhibitors or certain boosted protease inhibitors is recommended for all pregnant women with HIV-2 infection (AIII).
- Dolutegravir (irrespective of trimester), raltegravir, ritonavir-boosted darunavir, or ritonavir-boosted lopinavir plus a dual-nucleoside reverse transcriptase inhibitor (NRTI) backbone of abacavir plus lamivudine or tenofovir disoproxil fumarate plus emtricitabine or lamivudine are recommended for treating HIV-2 mono-infection in pregnant women and in women trying to conceive (AIII). Zidovudine (ZDV) plus lamivudine can be used as an alternative dual-NRTI backbone. See Updated Guidance about the Use of Dolutegravir in Pregnancy in Recommendations for the Use of Antiretroviral Drugs in Pregnancy and Appendix D: Dolutegravir Counseling Guide for Health Care Providers.
- As with HIV-1, the possibility of hepatitis B virus/HIV-2 co-infection should be considered when choosing an antiretroviral regimen to treat HIV-2 (AI), see Hepatitis B Virus/HIV Coinfection.
- All infants born to women with HIV-2 infection (who do not have HIV-1 infection) should receive the 4-week ZDV prophylactic regimen (BIII).
- In the United States, where safe infant formula is readily available, breastfeeding is not recommended for infants born to mothers with HIV-2 infection (AIII).