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Management of HIV infection in pregnant women (2008)

Introduction

The success of antenatal testing for HIV means that more clinicians than ever are involved in the care of women with HIV who are pregnant. Despite very few recent randomized controlled trials regarding the use of antiretroviral therapy (ART) in pregnancy or obstetric interventions, practice is changing. This is informed largely by observational data and theoretical considerations and these guidelines reflect this. The Cochrane Systematic Review of randomized controlled trials in this area shows how limited the guidelines would be were they to be restricted to such high-level evidence. Changes from the 2005 guidelines include the following.

  • A greater range of clinical scenarios to include more consideration of adverse obstetric events, especially prematurity. This reflects the nature and volume of calls to the Writing Committee from fellow clinicians.
  • Clearer recommendations regarding documentation of antenatal HIV testing, consideration to be given to repeat testing of women noted to be at continuing higher risk of HIV acquisition and advice to recommend near-patient HIV testing for untested women in labour.
  • A further reduction in detail on teratogenicity, as this is better covered by reference to the Antiretroviral Pregnancy Registry.
  • There are few substantive changes to the recommendations on the use of individual antiretroviral therapies. The option of zidovudine monotherapy plus pre-labour Caesarean section (PLCS) for selected women is supported by new data from the UK and Ireland cohort.
  • There is more detail in the obstetric management section, reflecting the greater diversity of clinical situations being encountered, in part as a result of more women choosing to take short-term antiretroviral therapy (START) and try for an elective vaginal delivery. Data from two large European cohorts provide support for planning a vaginal delivery if HIV virus is undetectable on highly active antiretroviral therapy (HAART).
  • The recommendations for infant feeding in the UK remain unchanged.

Downloads

British HIV Association and Children's HIV Association guidelines for the management of HIV infection in pregnant women 2008

Writing Group

Chair

  • Annemiek de Ruiter, (Guy’s & St Thomas' Hospital NHS Foundation Trust )

Members

  • Jane Anderson (Homerton University Hospital NHS Foundation Trust)
  • Rana Chakraborty (St George’s Hospital)
  • Polly Clayden (HIV i-Base)
  • Graham Foster (Barts and The London NHS Trust)
  • Carole Gilling-Smith (Chelsea and Westminster NHS Foundation Trust)
  • David Hawkins (Chelsea and Westminster NHS Foundation Trust)
  • Naomi Low-Beer (Imperial College London)
  • Danielle Mercey (Mortimer Market Centre)
  • Hermione Lyall (St Mary’s Hospital NHS Trust)
  • Siobhan O’Shea (Guy’s & St Thomas' Hospital NHS Foundation Trust)
  • Zoë Penn (Chelsea and Westminster NHS Foundation Trust)
  • Jennifer Short (Heart of England NHS Trust)
  • Richard Smith (Chelsea and Westminster NHS Foundation Trust)
  • Sonali Sonecha (Chelsea and Westminster NHS Foundation Trust)
  • Graham Taylor (Imperial College School of Medicine at St Mary's)
  • Pat Tookey (Institute of Child Health)
  • Chris Wood (North Middlesex University Hospital)

 

Reference

HIV Medicine (2008), 9, 452-502