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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Maternal HIV Testing and Identification of Perinatal HIV Exposure

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

Panel's Recommendations for Maternal Testing and Identification of Perinatal HIV Exposure
Panel's Recommendations
  • HIV testing is recommended as standard of care for all sexually active women and should be a routine component of preconception care (AII).
  • All pregnant women should be tested as early as possible during each pregnancy (see Laboratory Testing for the Diagnosis of HIV Infection: Updated Recommendations and Recommended Laboratory HIV Testing Algorithm) (AII).
  • Partners of pregnant women should be encouraged to undergo HIV testing when their status is unknown (AIII).
  • Repeat HIV testing in the third trimester is recommended for pregnant women with negative initial HIV antibody tests who are at increased risk of acquiring HIV, including those who are receiving care in facilities that have an HIV incidence of ≥1 case per 1,000 pregnant women per year, those who are incarcerated, those who reside in jurisdictions with elevated HIV incidence, or those who reside in states that require third-trimester testing (see Prenatal and Perinatal Human Immunodeficiency Virus Testing and Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings (AII).
  • Expedited HIV testing at the time of labor or delivery should be performed for any woman with undocumented HIV status; testing should be available 24 hours a day, and results should be available within 1 hour (AII). If results are positive, intrapartum antiretroviral (ARV) prophylaxis should be initiated immediately (AI) and infants should receive an ARV regimen that is appropriate for infants at higher risk of perinatal HIV transmission as soon as possible, pending results of supplemental HIV testing (AII). See Antiretroviral Management of Newborns with Perinatal HIV Exposure or Perinatal HIV for guidance.
  • Women who have not been tested for HIV before or during labor should undergo expedited HIV antibody testing during the immediate postpartum period (or their newborns should undergo expedited HIV antibody testing) (AII). If the results for the mother or infant are positive, an appropriate infant ARV drug regimen should be initiated immediately, and the mother should not breastfeed unless supplemental HIV testing is negative (AII). Infants with initial positive HIV viral tests (RNA, DNA) should have their ARV regimen modified, if necessary, to a three-drug combination of ARV drugs at treatment dosages (antiretroviral therapy) (see Antiretroviral Management of Newborns with Perinatal HIV Exposure or Perinatal HIV) (AII).
  • Results of maternal HIV testing should be documented in the newborn’s medical record and communicated to the newborn’s primary care provider (AIII).
  • HIV testing to determine HIV status is recommended for infants and children in foster care and adoptees for whom maternal HIV status is unknown (AIII).
Rating of Recommendations: A = Strong; B = Moderate; C = Optional

Rating of Evidence: I = One or more randomized trials in children with clinical outcomes and/or validated endpoints; I* = One or more randomized trials in adults with clinical outcomes and/or validated laboratory endpoints with accompanying data in children from one or more well-designed, nonrandomized trials or observational cohort studies with long-term clinical outcomes; II = One or more well-designed, nonrandomized trials or observational cohort studies in children with long-term outcomes; II* = One or more well-designed, nonrandomized trials or observational studies in adults with long-term clinical outcomes with accompanying data in children† from one or more similar nonrandomized trials or cohort studies with clinical outcome data; III = Expert opinion

Studies that include children or children and adolescents, but not studies limited to post-pubertal adolescents

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