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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HIV-2 Infection and Pregnancy

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

Panel's Recommendations Regarding HIV-2 Infection and Pregnancy
Panel's Recommendations
  • 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).
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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