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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Antepartum Care

Lack of Viral Suppression

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

Panel's Recommendations Regarding Lack of Viral Suppression
Panel's Recommendations
  • Because maternal antenatal viral load correlates with the risk of perinatal transmission of HIV, suppression of HIV RNA to undetectable levels should be achieved as rapidly as possible (AII).
  • If an ultrasensitive HIV RNA assay indicates failure of viral suppression (after an adequate period of treatment):
    • If HIV RNA level is >500 copies/mL, assess medication adherence, adherence to food requirements, and possible drug interactions and perform tests for resistance (AII).
    • Consult an HIV treatment expert and consider possible antiretroviral regimen modification (AIII).
  • Scheduled cesarean delivery at 38 weeks’ gestation is recommended for pregnant women living with HIV who have HIV RNA levels >1,000 copies/mL near the time of delivery (AII).
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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