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 24, 2019; Last Reviewed: December 24, 2019

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).
  • For pregnant women who have not achieved viral suppression (after an adequate period of treatment):
    • Assess medication adherence, tolerability, dosing, potential problems with absorption, adherence to food requirements, and possible drug interactions.
    • If HIV RNA is >500 copies/mL, perform tests for resistance (AII).
    • Consult an HIV treatment expert and consider possible antiretroviral regimen modification (AIII).
  • Intrapartum intravenous zidovudine prophylaxis and scheduled cesarean delivery at 38 weeks gestation are 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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