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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Intrapartum Care

Transmission and Mode of Delivery

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

Panel's Recommendations Regarding Transmission and Mode of Delivery
Panel's Recommendations
  • Scheduled cesarean delivery at 38 weeks gestation to minimize perinatal transmission of HIV is recommended for women with HIV RNA levels >1,000 copies/mL or unknown HIV levels near the time of delivery, irrespective of administration of antepartum antiretroviral therapy (ART) (AII).
  • Scheduled cesarean delivery performed solely for prevention of perinatal transmission in women receiving ART with HIV RNA ≤1,000 copies/mL is not routinely recommended given the low rate of perinatal transmission in this group (AII).
  • In women with HIV RNA levels ≤1,000 copies/mL, if scheduled cesarean delivery or induction is indicated, it should be performed at the standard time for obstetrical indications (AII).
  • In women with an HIV RNA >1,000 copies/mL or unknown HIV RNA level who present in spontaneous labor or with ruptured membranes, there is insufficient evidence to determine whether cesarean delivery reduces the risk of perinatal HIV transmission. Management of women originally scheduled for cesarean delivery because of HIV who present in labor must be individualized at the time of presentation (BII). In these circumstances, consultation with an expert in perinatal HIV (e.g., telephone consultation with the National Perinatal HIV/AIDS Clinical Consultation Center at 888-448-8765) may be helpful in rapidly developing an individualized delivery plan.
  • In women on ART with HIV RNA ≤1,000 copies/mL, duration of ruptured membranes is not associated with an increased risk of perinatal transmission, and vaginal delivery is recommended (BII).
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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