Management of HIV in Pregnancy and Postpartum Clinical Practice Guidelines (2019)

British HIV Association (BHIVA)

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

April 03, 2019

Neonatal Management

Two weeks of zidovudine monotherapy should be used if the mother has been on cART for more than 10 weeks, has two recorded maternal HIV viral loads during pregnancy <50 HIV RNA copies/mL at least 4 weeks apart, and a maternal HIV viral load <50 HIV RNA copies/mL at 36 weeks. Four weeks of zidovudine monotherapy is recommended if these factors are not met or if the infant is born prematurely.

Combination infant postexposure prophylaxis should be used if maternal birth HIV viral load is >50 HIV RNA copies/mL or if it is not known.

Infant postexposure prophylaxis should not be used for more than four weeks.

Use co-trimoxazole prophylaxis from 1 month of age in cases with a positive HIV PCR screening or where there is a confirmed HIV diagnosis in the infant.

Rotavirus vaccine is not contraindicated unless infant has confirmed HIV diagnosis and has severe immunosuppression.

Offer cabergoline to suppress lactation for patients who are not breastfeeding by choice or due to a viral load >50 HIV RNA copies/mL.

Perform molecular diagnostics for HIV infection in non-breastfed infants during the first 48 hours and before hospital discharge, at two weeks of age if they are high risk, at six and twelve weeks, and in instances when there is an additional risk.

Perform molecular diagnostics for HIV infection in breastfed infants during the first 48 hours and prior to hospital discharge, at two weeks of age and monthly during breastfeeding, and at four and eight weeks after breastfeeding has been stopped.

Check HIV antibody testing for seroreversion between 18-24 months of age.

Postpartum Management

Recommend all patients continue cART postpartum.

Assess the patient's mental health needs and refer for appropriate services.

Schedule cytology three months after delivery.

For more Clinical Practice Guidelines, please go to Guidelines.

For more information, go to HIV in Pregnancy.

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