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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Postpartum Follow-Up of Women Living with HIV Infection

Last Updated: December 24, 2019; Last Reviewed: December 24, 2019

Panel's Recommendations for Postpartum Follow-Up of Women Living with HIV
Panel's Recommendations
  • Antiretroviral therapy (ART) is currently recommended for all individuals living with HIV to reduce the risk of disease progression and to prevent the sexual transmission of HIV (AI).
  • ART should be continued after delivery (AI). Any plans for modifying ART after delivery should be made in consultation with the woman and her HIV care provider, ideally before delivery, taking into consideration the recommended regimens for nonpregnant adults (AIII) and plans for future pregnancies.
  • Clinicians should discuss future reproductive plans and timing, as well as the risks and benefits of conceiving on specific ARV medications, and the use of appropriate contraceptive options to prevent unintended pregnancy (AIII).
  • Because the immediate postpartum period poses unique challenges to antiretroviral (ARV) adherence, arrangements for new or continued supportive services should be made before hospital discharge (AII).
  • Contraceptive counseling should start during the prenatal period; a contraceptive plan should be developed prior to hospital discharge (AIII).
  • Women with a positive rapid HIV antibody test during labor require immediate linkage to HIV care and comprehensive follow-up, including for confirmation of HIV infection (AII).
  • Prior to hospital discharge, the woman should be given ARV medications for herself and her newborn to take at home (AIII).
  • Breastfeeding is not recommended for women in the United States who have confirmed HIV or are presumed to be living with HIV because safer infant feeding alternatives are available (AI).
  • Infant feeding counseling, including a discussion of potential barriers to formula feeding, should begin during the prenatal period, and this information should be reviewed after delivery (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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