Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States

Publication Date: January 31, 2024
Last Updated: February 1, 2024

Maternal HIV Testing and Identification of Perinatal HIV Exposure

•HIV testing is recommended as a standard of care for all sexually active people and should be a routine componentof preconception care (AII).

•All pregnant people should be tested as early as possible during each pregnancy (see Laboratory Testing for theDiagnosis of HIV Infection: Updated Recommendations and Recommended Laboratory HIV Testing Algorithm forSerum or Plasma Specimens from the Centers for Disease Control and Prevention [CDC]) (AII).

•Partners of all pregnant people should be referred for HIV testing when their status is unknown (AIII).

•Repeat HIV testing in the third trimester is recommended for pregnant people with negative initial HIV tests who areat increased risk of acquiring HIV, including those receiving care in facilities that have an HIV incidence of ≥1 caseper 1,000 pregnant women per year, those who reside in jurisdictions with elevated HIV incidence (see RevisedRecommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings fromCDC), or those who reside in states or territories that require third-trimester testing (AII).

•Repeat HIV testing is recommended for pregnant people with a sexually transmitted infection (STI) or with signsand symptoms of acute HIV infection, or ongoing exposure to HIV, as well as referral for initiation of pre-exposureprophylaxis if HIV testing is negative (AIII). See Pre-Exposure Prophylaxis (PrEP) to Prevent HIV DuringPericonception, Antepartum, and Postpartum Periods for more information.

•Expedited HIV testing should be performed during labor or delivery for people with undocumented HIV status andfor those who tested negative early in pregnancy but are at increased risk of HIV infection and were not retested inthe third trimester (AII). Testing should be available 24 hours a day, and results should be available within 1 hour. Ifresults are positive, intrapartum antiretroviral (ARV) prophylaxis should be initiated immediately (AI).

•Pregnant people who were not tested for HIV before or during labor should undergo expedited HIV antibody testingduring the immediate postpartum period (or their newborns should undergo expedited HIV antibody testing) (AII).

•When a pregnant person has a positive HIV test result during labor and delivery or postpartum, or when anewborn’s expedited antibody test is positive, an appropriate infant ARV drug regimen should be initiatedimmediately, and the infant should not be breastfed while awaiting the results of supplemental HIV testing (AII).See Antiretroviral Management of Newborns with Perinatal HIV Exposure or Perinatal HIV for guidance.

•Results of maternal HIV testing should be documented in the newborn’s medical record and communicated to thenewborn’s primary care provider (AIII).

•HIV testing is recommended for infants and children in foster care and adoptees for whom maternal HIV status isunknown to identify perinatal HIV exposure and possible HIV infection (AIII) (see Diagnosis of HIV Infections inInfants and Children).

Prepregnancy Counseling and Care for Persons of Childbearing Age with HIV

•Discuss reproductive desires with all persons of childbearing potential on an ongoing basis throughout thecourse of their care (AIII).

•Provide information about effective and appropriate contraceptive methods to people who do not currentlydesire pregnancy (AI).

•During prepregnancy counseling, provide information on safe sex; ask about the use of alcohol, nicotineproducts, and drugs of abuse (AII).

•Persons with HIV should attain maximum viral suppression before attempting conception, for their own health,to prevent sexual HIV transmission to partners without HIV (AI), and to minimize the risk of in utero HIVtransmission to the infant (AI).

•When selecting or evaluating an antiretroviral (ARV) regimen for persons of childbearing potential with HIV,consider a regimen’s effectiveness, a person’s hepatitis B status, and the possible adverse outcomes for thepregnant person and their fetus (AII). See Teratogenicity and Recommendations for Use of Antiretroviral DrugsDuring Pregnancy for more information. The Panel on Treatment of HIV During Pregnancy and Prevention ofPerinatal Transmission (the Panel) emphasizes the importance of counseling and shared decision-makingregarding all ARV regimens for persons with HIV (AIII).

•HIV infection does not preclude the use of any contraceptive method; however, drug-drug interactions betweenhormonal contraceptives, ARVs, and other medications should be considered (see Table 3) (AII).

Overview

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Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States

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