Clinical Review

HIV management in pregnancy

OBG Manag. 2022 August;34(8):16-23 | doi: 10.12788/obgm.0214

References

Samji H, Cescon A, Hogg RS, et al; North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA. Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One. 2013;8:e81355. doi: 10.1371/journal. pone.0081355.
Centers for Disease Control and Prevention. May 1, 2021. HIV Surveillance Report, 2019, vol. 32: Diagnosis of HIV infection in the United States and dependent areas, 2019. Accessed February 15, 2022. http://www.cdc.gov/hiv/library/reports /hiv-surveillance.html
Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV. Guidelines for the use of antiretroviral agents in pediatric HIV infection. https: //clinicalinfo.hiv.gov/en/guidelines/pediatric-arv. Accessed February 15, 2022.
Connor EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J Med. 1994;331:1173-1180.
Townsend CL, Byrne L, Cortina-Borja M, et al. Earlier initiation of ART and further decline in mother-to-child HIV transmission rates, 2000-2011. AIDS. 2014;28:1049-1057.
Centers for Disease Control and Prevention. January 26, 2022. HIV and pregnant women, infants, and children. Accessed February 15, 2022. https://www.cdc.gov/hiv/group/gender /pregnantwomen/index.html
Centers for Disease Control and Prevention. 2018 Quick reference guide: Recommended laboratory HIV testing algorithm for serum or plasma specimens. National Center for HIV/AIDS, Viral Hepatitis, and TB Prevention (US); Division of HIV/AIDS Prevention; Association of Public Health Laboratories. Updated January 2018. https://stacks. cdc.gov/view/cdc/50872
Centers for Disease Control and Prevention, Association of Public Health Laboratories. June 27, 2014. Laboratory testing for the diagnosis of HIV infection: updated recommendations. Accessed February 15, 2022. http://stacks.cdc.gov/view /cdc/23447
Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV. Updated April 12, 2022. Accessed July 6, 2022. https://clinicalinfo.hiv .gov/en/guidelines/adult-and-adolescent-opportunistic -infection/whats-new-guidelines
Rubin LG, Levin MJ, Ljungman P, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2014;58: e44–e100. doi: 10.1093/cid/cit684.
Centers for Disease Control and Prevention. ACIP: Guidance for vaccine recommendations for pregnant and breastfeeding women. Accessed July 5, 2022. https://www.cdc.gov /vaccines/hcp/acip-recs/rec-vac-preg.html?CDC_AA _refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Facip %2Fcommittee%2Fguidance%2Frec-vac-preg.html
Perkins RB, Guido RS, Castle PE, et al; for the 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis. 2020;24:102-131. doi: 10.1097/LGT.0000000000000525. Erratum in: J Low Genit Tract Dis. 2020;24:427.
Cohen MS, Chen YQ, McCauley M, et al; HPTN 052 Study Team. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365:493-505.
Drug interactions between antiretroviral agents and hormonal contraceptives. Accessed July 6, 2022. https://clinicalinfo .hiv.gov/en/table/table-3-drug-interactions-between -antiretroviral-agents-and-hormonal-contraceptives
Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission. Recommendations for use of antiretroviral drugs in pregnancy and interventions to reduce perinatal HIV transmission in the United States. Accessed July 7, 2022. https://clinicalinfo.hiv.gov/en/guidelines/perinatal /whats-new-guidelines
Centers for Disease Control and Prevention. Recommendations for partner services programs for HIV infection, syphilis, gonorrhea, and chlamydial infection. MMWR Recomm Rep. 2008;57(RR-9):1–83.
Gilead Sciences, Inc. Truvada (emtricitabine 200 mg/ tenofovir disoproxil fumarate 300 mg tablets). Accessed July 6, 2022. https://truvada.com
Centers for Disease Control and Prevention. Interim guidance for clinicians considering the use of preexposure prophylaxis for the prevention of HIV infection in heterosexually active adults. MMWR Morb Mortal Wkly Rep. 2012;61:586-589.
Baeten JM, Donnell D, Ndase P, et al; Partners PrEP Study Team. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367: 399-410.
Celum C, Baeten JM. Antiretroviral-based HIV-1 prevention: antiretroviral treatment and pre-exposure prophylaxis. Antivir Ther. 2012;17:1483-1493.
Thigpen MC, Kebaabetswe PM, Paxton LA, et al; TDF2 Study Group. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med. 2012;367:423-434.
Society for Maternal-Fetal Medicine. Special statement: updated checklists for pregnancy management in persons with HIV. Accessed July 5, 2022. https://www.smfm.org /publications/334-smfm-special-statement-updated -checklists-for-pregnancy-management-in-persons-with-hiv
American College of Obstetricians and Gynecologists. ACOG committee opinion no. 752. Prenatal and perinatal human immunodeficiency virus testing. Obstet Gynecol. 2018;132:e138-e142.
Human immunodeficiency virus screening. Joint statement of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. Pediatrics. 1999;104(1 pt 1):128.
Branson BM, Handsfield HH, Lampe MA, et al; Centers for Disease Control and Prevention. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health care settings. MMWR Recomm Rep. 2006; 55(RR-14):1-17.
American College of Obstetricians and Gynecologists. ACOG committee opinion no. 751. Labor and delivery management of women with human immunodeficiency virus infection. Obstet Gynecol. 2018;132:e131-e137.
Centers for Disease Control and Prevention. Factors increasing the risk of acquiring or transmitting HIV. November 12, 2019. Accessed July 29, 2022. https://www.cdc .gov/hiv/risk/estimates/riskfactors.html
Mandelbrot L, Le Chenadec J, Berrebi A, et al. Perinatal HIV1 transmission: interaction between zidovudine prophylaxis and mode of delivery in the French Perinatal Cohort. JAMA. 1998;280:55-60.
European Mode of Delivery Collaboration. Elective caesarean-section versus vaginal delivery in prevention of vertical HIV-1 transmission: a randomised clinical trial. Lancet. 1999;353:1035-1039.
International Perinatal HIV Group; Andiman W, Bryson Y, de Martino M, et al. The mode of delivery and the risk of vertical transmission of human immunodeficiency virus type 1—a meta-analysis of 15 prospective cohort studies. N Engl J Med. 1999;340:977-987.
Briand N, Jasseron C, Sibiude J, et al. Cesarean section for HIV-infected women in the combination antiretroviral therapies era, 2000–2010. Am J Obstet Gynecol. 2013;209: 335.e1-335.e12.
Scott RK, Chakhtoura N, Burke MM, et al. Delivery after 40 weeks of gestation in pregnant women with well-controlled human immunodeficiency virus. Obstet Gynecol. 2017;130:502-510.
American College of Obstetricians and Gynecologists. Committee opinion no. 560. Medically indicated late-preterm and early-term deliveries. Obstet Gynecol. 2013;121:908-910.
Mofenson LM, Lambert JS, Stiehm ER, et al. Risk factors for perinatal transmission of human immunodeficiency virus type 1 in women treated with zidovudine. Pediatric AIDS Clinical Trials Group Study 185 Team. N Engl J Med. 1999;341:385-393.
Garcia PM, Kalish LA, Pitt J, et al. Maternal levels of plasma human immunodeficiency virus type 1 RNA and the risk of perinatal transmission. Women and Infants Transmission Study Group. N Engl J Med. 1999;341:394-402.
Briand N, Warszawski J, Mandelbrot L, et al; ANRS-EPF CO1CO11 Study Group. Is intrapartum intravenous zidovudine for prevention of mother-to-child HIV-1 transmission still useful in the combination antiretroviral therapy era? Clin Infect Dis. 2013;57:903-914.
Myer L, Phillips TK, McIntyre JA, et al. HIV viraemia and mother-to-child transmission risk after antiretroviral therapy initiation in pregnancy in Cape Town, South Africa. HIV Med. 2017;18:80-88.
Rodman JH, Flynn PM, Robbins B, et al. Systemic pharmacokinetics and cellular pharmacology of zidovudine in human immunodeficiency virus type 1-infected women and newborn infants. J Infect Dis. 1999;180:1844-1850.
Wade NA, Birkhead GS, Warren BL, et al. Abbreviated regimens of zidovudine prophylaxis and perinatal transmission of the human immunodeficiency virus. N Engl J Med. 1998;339:1409-1414.
Nielsen-Saines K, Watts HD, Veloso VS, et al; NICHD HPTN 040/PACTG 1043 Protocol Team. Three postpartum antiretroviral regimens to prevent intrapartum HIV infection. N Engl J Med. 2012;366:2368-2379.
Mandelbrot L, Mayaux MJ, Bongain A, et al. Obstetric factors and mother-to-child transmission of human immunodeficiency virus type 1: the French perinatal cohorts. SEROGEST French Pediatric HIV Infection Study Group. Am J Obstet Gynecol. 1996;175(3 pt 1):661-667.
Shapiro DE, Sperling RS, Mandelbrot L, et al. Risk factors for perinatal human immunodeficiency virus transmission in patients receiving zidovudine prophylaxis. Pediatric AIDS Clinical Trials Group protocol 076 Study Group. Obstet Gynecol. 1999;94:897-908.
International Perinatal HIV Group. Duration of ruptured membranes and vertical transmission of HIV-1: a meta-analysis from 15 prospective cohort studies. AIDS. 2001;15:357-368.
Nielsen TF, Hokegard KH. Postoperative cesarean section morbidity: a prospective study. Am J Obstet Gynecol. 1983;146:911-916.
Mark S, Murphy KE, Read S, et al. HIV mother-to-child transmission, mode of delivery, and duration of rupture of membranes: experience in the current era. Infect Dis Obstet Gynecol. 2012;2012:267969.
Cotter AM, Brookfield KF, Duthely LM, et al. Duration of membrane rupture and risk of perinatal transmission of HIV1 in the era of combination antiretroviral therapy. Am J Obstet Gynecol. 2012;207:482.e1-482.e5.
Peters H, Byrne L, De Ruiter A, et al. Duration of ruptured membranes and mother-to-child HIV transmission: a prospective population-based surveillance study. BJOG. 2016;123:975-981.
Jamieson DJ, Read JS, Kourtis AP, et al. Cesarean delivery for HIV-infected women: recommendations and controversies. Am J Obstet Gynecol. 2007;197(3 suppl):S96-S100.
Cambic CR, Avram MJ, Gupta DK, et al. Effect of ritonavir-induced cytochrome P450 3A4 inhibition on plasma fentanyl concentrations during patient-controlled epidural labor analgesia: a pharmacokinetic simulation. Int J Obstet Anesth. 2014;23:45-51.
Navarro J, Curran A, Burgos J, et al. Acute leg ischaemia in an HIV-infected patient receiving antiretroviral treatment. Antivir Ther. 2017;22:89-90.
American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care. 8th ed. American Academy of Pediatrics, American College of Obstetricians and Gynecologists; 2017.
Siberry GK, Abzug MJ, Nachman S, et al; Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children: recommendations from the National Institutes of Health, Centers for Disease Control and Prevention, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics. Pediatr Infect Dis J. 32(suppl 2[0 2]):i–KK4.
Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV. Guidelines for the use of antiretroviral agents in pediatric HIV infection. Accessed February 15, 2022. https://clinicalinfo.hiv.gov/en/guidelines /pediatric-arv
Committee on Health Care for Underserved Women, American College of Obstetricians and Gynecologists. ACOG committee opinion no. 361. Breastfeeding: maternal and infant aspects. Obstet Gynecol. 2007;109(2 pt 1):479-480.
Committee on Pediatric AIDS; Mofenson LM, Flynn PM, Aldrovandi GM, et al. Infant feeding and transmission of human immunodeficiency virus in the United States. Pediatrics. 2013;131:391-396.
Breastfeeding and HIV International Transmission Study Group; Coutsoudis A, Dabis F, Fawzi W, et al. Late postnatal transmission of HIV-1 in breast-fed children: an individual patient data meta-analysis. J Infect Dis. 2004;189:2154-2166.

Postpartum care

Postpartum contraception should be offered and provided in accordance with patient request. Regardless of other birth control methods, strict condom use should be advised. PrEP should be discussed and offered for all partners of serodiscordant couples.

Upon outpatient follow-up, assessment and provision of routine health maintenance should be performed. Any abnormal cervical pathology encountered during prenatal care should be managed in accordance with ASCCP guidelines.¹² Follow-up care should be established with adult medicine, infectious disease, and ObGyn clinicians.²⁶

Neonatal considerations

Neonates born to mothers with positive or unknown HIV status should undergo expedited HIV testing.^51,52 Consultation should be conducted with pediatric or neonatology colleagues to determine the antiretroviral regimen and duration of therapy based on presumed HIV status of the neonate. Ideally, antiretroviral therapy should be initiated within 6 hours of delivery.^3,53

Formula feeding should be implemented as maternal HIV infection is one of the few contraindications to breastfeeding.^54,55 The risk of late breast milk transmission, defined as postnatal transmission that occurs after 1 month of age, may vary based on maternal viral load, but it has been reported as high as 8.9 transmissions per 100 person-years of breastfeeding.⁵⁶

Resources available

Care of the pregnant patient with HIV and the reduction of perinatal transmission both depend on early diagnosis of HIV and effective treatment with cART. Such patients benefit from a team-based care model that includes the ObGyn and/or MFM specialist, infectious disease clinician, pediatrician, and social worker. As guidelines evolve for care of these patients, a reference checklist, such as the examples provided at the Society for Maternal-Fetal Medicine website (smfm.org) or at HIV.gov, provide an outline for:

management before, during, and after pregnancy
suggestions for management teams of interest to successfully carry out the checklist requirements
proposals for measurements of quality performance with the use of checklists in the management of HIV in pregnancy.

In addition, assistance with clinical decision making for patients with HIV in pregnancy can be obtained via telephone consultation with the National Clinician Consultation Center–Perinatal HIV/AIDS (888-448-8765), which is available 24 hours a day, 7 days a week. ●

References

Samji H, Cescon A, Hogg RS, et al; North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA. Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One. 2013;8:e81355. doi: 10.1371/journal. pone.0081355.
Centers for Disease Control and Prevention. May 1, 2021. HIV Surveillance Report, 2019, vol. 32: Diagnosis of HIV infection in the United States and dependent areas, 2019. Accessed February 15, 2022. http://www.cdc.gov/hiv/library/reports /hiv-surveillance.html
Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV. Guidelines for the use of antiretroviral agents in pediatric HIV infection. https: //clinicalinfo.hiv.gov/en/guidelines/pediatric-arv. Accessed February 15, 2022.
Connor EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J Med. 1994;331:1173-1180.
Townsend CL, Byrne L, Cortina-Borja M, et al. Earlier initiation of ART and further decline in mother-to-child HIV transmission rates, 2000-2011. AIDS. 2014;28:1049-1057.
Centers for Disease Control and Prevention. January 26, 2022. HIV and pregnant women, infants, and children. Accessed February 15, 2022. https://www.cdc.gov/hiv/group/gender /pregnantwomen/index.html
Centers for Disease Control and Prevention. 2018 Quick reference guide: Recommended laboratory HIV testing algorithm for serum or plasma specimens. National Center for HIV/AIDS, Viral Hepatitis, and TB Prevention (US); Division of HIV/AIDS Prevention; Association of Public Health Laboratories. Updated January 2018. https://stacks. cdc.gov/view/cdc/50872
Centers for Disease Control and Prevention, Association of Public Health Laboratories. June 27, 2014. Laboratory testing for the diagnosis of HIV infection: updated recommendations. Accessed February 15, 2022. http://stacks.cdc.gov/view /cdc/23447
Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV. Updated April 12, 2022. Accessed July 6, 2022. https://clinicalinfo.hiv .gov/en/guidelines/adult-and-adolescent-opportunistic -infection/whats-new-guidelines
Rubin LG, Levin MJ, Ljungman P, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2014;58: e44–e100. doi: 10.1093/cid/cit684.
Centers for Disease Control and Prevention. ACIP: Guidance for vaccine recommendations for pregnant and breastfeeding women. Accessed July 5, 2022. https://www.cdc.gov /vaccines/hcp/acip-recs/rec-vac-preg.html?CDC_AA _refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Facip %2Fcommittee%2Fguidance%2Frec-vac-preg.html
Perkins RB, Guido RS, Castle PE, et al; for the 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis. 2020;24:102-131. doi: 10.1097/LGT.0000000000000525. Erratum in: J Low Genit Tract Dis. 2020;24:427.
Cohen MS, Chen YQ, McCauley M, et al; HPTN 052 Study Team. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365:493-505.
Drug interactions between antiretroviral agents and hormonal contraceptives. Accessed July 6, 2022. https://clinicalinfo .hiv.gov/en/table/table-3-drug-interactions-between -antiretroviral-agents-and-hormonal-contraceptives
Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission. Recommendations for use of antiretroviral drugs in pregnancy and interventions to reduce perinatal HIV transmission in the United States. Accessed July 7, 2022. https://clinicalinfo.hiv.gov/en/guidelines/perinatal /whats-new-guidelines
Centers for Disease Control and Prevention. Recommendations for partner services programs for HIV infection, syphilis, gonorrhea, and chlamydial infection. MMWR Recomm Rep. 2008;57(RR-9):1–83.
Gilead Sciences, Inc. Truvada (emtricitabine 200 mg/ tenofovir disoproxil fumarate 300 mg tablets). Accessed July 6, 2022. https://truvada.com
Centers for Disease Control and Prevention. Interim guidance for clinicians considering the use of preexposure prophylaxis for the prevention of HIV infection in heterosexually active adults. MMWR Morb Mortal Wkly Rep. 2012;61:586-589.
Baeten JM, Donnell D, Ndase P, et al; Partners PrEP Study Team. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367: 399-410.
Celum C, Baeten JM. Antiretroviral-based HIV-1 prevention: antiretroviral treatment and pre-exposure prophylaxis. Antivir Ther. 2012;17:1483-1493.
Thigpen MC, Kebaabetswe PM, Paxton LA, et al; TDF2 Study Group. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med. 2012;367:423-434.
Society for Maternal-Fetal Medicine. Special statement: updated checklists for pregnancy management in persons with HIV. Accessed July 5, 2022. https://www.smfm.org /publications/334-smfm-special-statement-updated -checklists-for-pregnancy-management-in-persons-with-hiv
American College of Obstetricians and Gynecologists. ACOG committee opinion no. 752. Prenatal and perinatal human immunodeficiency virus testing. Obstet Gynecol. 2018;132:e138-e142.
Human immunodeficiency virus screening. Joint statement of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. Pediatrics. 1999;104(1 pt 1):128.
Branson BM, Handsfield HH, Lampe MA, et al; Centers for Disease Control and Prevention. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health care settings. MMWR Recomm Rep. 2006; 55(RR-14):1-17.
American College of Obstetricians and Gynecologists. ACOG committee opinion no. 751. Labor and delivery management of women with human immunodeficiency virus infection. Obstet Gynecol. 2018;132:e131-e137.
Centers for Disease Control and Prevention. Factors increasing the risk of acquiring or transmitting HIV. November 12, 2019. Accessed July 29, 2022. https://www.cdc .gov/hiv/risk/estimates/riskfactors.html
Mandelbrot L, Le Chenadec J, Berrebi A, et al. Perinatal HIV1 transmission: interaction between zidovudine prophylaxis and mode of delivery in the French Perinatal Cohort. JAMA. 1998;280:55-60.
European Mode of Delivery Collaboration. Elective caesarean-section versus vaginal delivery in prevention of vertical HIV-1 transmission: a randomised clinical trial. Lancet. 1999;353:1035-1039.
International Perinatal HIV Group; Andiman W, Bryson Y, de Martino M, et al. The mode of delivery and the risk of vertical transmission of human immunodeficiency virus type 1—a meta-analysis of 15 prospective cohort studies. N Engl J Med. 1999;340:977-987.
Briand N, Jasseron C, Sibiude J, et al. Cesarean section for HIV-infected women in the combination antiretroviral therapies era, 2000–2010. Am J Obstet Gynecol. 2013;209: 335.e1-335.e12.
Scott RK, Chakhtoura N, Burke MM, et al. Delivery after 40 weeks of gestation in pregnant women with well-controlled human immunodeficiency virus. Obstet Gynecol. 2017;130:502-510.
American College of Obstetricians and Gynecologists. Committee opinion no. 560. Medically indicated late-preterm and early-term deliveries. Obstet Gynecol. 2013;121:908-910.
Mofenson LM, Lambert JS, Stiehm ER, et al. Risk factors for perinatal transmission of human immunodeficiency virus type 1 in women treated with zidovudine. Pediatric AIDS Clinical Trials Group Study 185 Team. N Engl J Med. 1999;341:385-393.
Garcia PM, Kalish LA, Pitt J, et al. Maternal levels of plasma human immunodeficiency virus type 1 RNA and the risk of perinatal transmission. Women and Infants Transmission Study Group. N Engl J Med. 1999;341:394-402.
Briand N, Warszawski J, Mandelbrot L, et al; ANRS-EPF CO1CO11 Study Group. Is intrapartum intravenous zidovudine for prevention of mother-to-child HIV-1 transmission still useful in the combination antiretroviral therapy era? Clin Infect Dis. 2013;57:903-914.
Myer L, Phillips TK, McIntyre JA, et al. HIV viraemia and mother-to-child transmission risk after antiretroviral therapy initiation in pregnancy in Cape Town, South Africa. HIV Med. 2017;18:80-88.
Rodman JH, Flynn PM, Robbins B, et al. Systemic pharmacokinetics and cellular pharmacology of zidovudine in human immunodeficiency virus type 1-infected women and newborn infants. J Infect Dis. 1999;180:1844-1850.
Wade NA, Birkhead GS, Warren BL, et al. Abbreviated regimens of zidovudine prophylaxis and perinatal transmission of the human immunodeficiency virus. N Engl J Med. 1998;339:1409-1414.
Nielsen-Saines K, Watts HD, Veloso VS, et al; NICHD HPTN 040/PACTG 1043 Protocol Team. Three postpartum antiretroviral regimens to prevent intrapartum HIV infection. N Engl J Med. 2012;366:2368-2379.
Mandelbrot L, Mayaux MJ, Bongain A, et al. Obstetric factors and mother-to-child transmission of human immunodeficiency virus type 1: the French perinatal cohorts. SEROGEST French Pediatric HIV Infection Study Group. Am J Obstet Gynecol. 1996;175(3 pt 1):661-667.
Shapiro DE, Sperling RS, Mandelbrot L, et al. Risk factors for perinatal human immunodeficiency virus transmission in patients receiving zidovudine prophylaxis. Pediatric AIDS Clinical Trials Group protocol 076 Study Group. Obstet Gynecol. 1999;94:897-908.
International Perinatal HIV Group. Duration of ruptured membranes and vertical transmission of HIV-1: a meta-analysis from 15 prospective cohort studies. AIDS. 2001;15:357-368.
Nielsen TF, Hokegard KH. Postoperative cesarean section morbidity: a prospective study. Am J Obstet Gynecol. 1983;146:911-916.
Mark S, Murphy KE, Read S, et al. HIV mother-to-child transmission, mode of delivery, and duration of rupture of membranes: experience in the current era. Infect Dis Obstet Gynecol. 2012;2012:267969.
Cotter AM, Brookfield KF, Duthely LM, et al. Duration of membrane rupture and risk of perinatal transmission of HIV1 in the era of combination antiretroviral therapy. Am J Obstet Gynecol. 2012;207:482.e1-482.e5.
Peters H, Byrne L, De Ruiter A, et al. Duration of ruptured membranes and mother-to-child HIV transmission: a prospective population-based surveillance study. BJOG. 2016;123:975-981.
Jamieson DJ, Read JS, Kourtis AP, et al. Cesarean delivery for HIV-infected women: recommendations and controversies. Am J Obstet Gynecol. 2007;197(3 suppl):S96-S100.
Cambic CR, Avram MJ, Gupta DK, et al. Effect of ritonavir-induced cytochrome P450 3A4 inhibition on plasma fentanyl concentrations during patient-controlled epidural labor analgesia: a pharmacokinetic simulation. Int J Obstet Anesth. 2014;23:45-51.
Navarro J, Curran A, Burgos J, et al. Acute leg ischaemia in an HIV-infected patient receiving antiretroviral treatment. Antivir Ther. 2017;22:89-90.
American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care. 8th ed. American Academy of Pediatrics, American College of Obstetricians and Gynecologists; 2017.
Siberry GK, Abzug MJ, Nachman S, et al; Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children: recommendations from the National Institutes of Health, Centers for Disease Control and Prevention, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics. Pediatr Infect Dis J. 32(suppl 2[0 2]):i–KK4.
Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV. Guidelines for the use of antiretroviral agents in pediatric HIV infection. Accessed February 15, 2022. https://clinicalinfo.hiv.gov/en/guidelines /pediatric-arv
Committee on Health Care for Underserved Women, American College of Obstetricians and Gynecologists. ACOG committee opinion no. 361. Breastfeeding: maternal and infant aspects. Obstet Gynecol. 2007;109(2 pt 1):479-480.
Committee on Pediatric AIDS; Mofenson LM, Flynn PM, Aldrovandi GM, et al. Infant feeding and transmission of human immunodeficiency virus in the United States. Pediatrics. 2013;131:391-396.
Breastfeeding and HIV International Transmission Study Group; Coutsoudis A, Dabis F, Fawzi W, et al. Late postnatal transmission of HIV-1 in breast-fed children: an individual patient data meta-analysis. J Infect Dis. 2004;189:2154-2166.

HIV management in pregnancy

References

Postpartum care

Neonatal considerations

Resources available

Pages

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