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

Acute HIV Infection

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

Panel's Recommendations Regarding Acute HIV Infection
Panel's Recommendations
  • When acute HIV infection is suspected in pregnancy or during breastfeeding, a plasma HIV RNA test should be obtained in conjunction an antigen/antibody immunoassay test (see Acute and Recent [Early] HIV Infection in the Adult and Adolescent Antiretroviral Guidelines and the Centers for Disease Control and Prevention HIV testing algorithm for more information) (AII).
  • Repeat HIV testing in the third trimester is recommended for pregnant women with initial negative HIV test results who are known to be at risk of acquiring HIV, who are receiving care in facilities that have an HIV incidence of ≥1 case per 1,000 pregnant women per year, those who reside in jurisdictions with elevated HIV incidence, or those who reside in states that require third-trimester testing (see Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health Care Settings) (AII).
  • All pregnant women with acute or recent HIV infection should start antiretroviral therapy (ART) as soon as possible to prevent perinatal transmission, with the goal of rapidly suppressing plasma HIV RNA below detectable levels (AI).
  • In women with acute HIV infection, baseline genotypic resistance testing should be performed simultaneously with initiation of ART (AII), and the regimen should be adjusted, if necessary, to optimize virologic response (BIII).
  • Dolutegravir plus tenofovir disoproxil fumarate (TDF) plus emtricitabine (FTC) is the Preferred ART regimen for pregnant and breastfeeding women with acute HIV, irrespective of trimester (see Table 4, Table 5, and Recommendations for Use of Antiretroviral Drugs During Pregnancy and Appendix D: Dolutegravir Counseling Guide for Health Care Providers) (AII).
    • Alternatively, raltegravir plus TDF plus FTC or a regimen that includes a ritonavir-boosted protease inhibitor can be initiated (AIII). See Table 4, Table 5, and Updated Guidance about the Use of Dolutegravir in Pregnancy in Recommendations for Use of Antiretroviral Drugs During Pregnancy for more information.
    • The Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission emphasizes the importance of counseling and informed decision-making regarding all antiretroviral (ARV) regimens for people living with HIV (AIII).
  • Lactating women who receive a diagnosis of acute HIV infection should be counseled to discontinue breastfeeding.
  • Infants born to women who received a diagnosis of acute HIV infection during pregnancy or breastfeeding are at high risk of perinatal HIV transmission and should receive an ARV regimen that is appropriate for this elevated risk (see Table 6 in Antiretroviral Management of Newborns with Perinatal HIV Exposure or HIV Infection) (AII). Consulting a pediatric HIV specialist regarding appropriate infant management is strongly recommended (see Antiretroviral Management of Newborns with Perinatal HIV Exposure or HIV Infection).
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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