Advice from the British HIV Association (BHIVA)

This guidance was updated on 2 September 2021; click here to see the latest version

Wednesday 25 March 2020

Management of a woman living with HIV while pregnant during COVID-19

Monitoring by HIV physicians may be reduced based on clinician assessment of HIV treatment and its efficacy but with a minimum of one initial contact/bloods (virtual or in person), one second trimester contact (virtual or in person) and one final visit in person at 36/40 for bloods and confirmation of the birth plan. Should further support be required antenatally and/or postnatally, virtual follow-up by phone is encouraged.

Breastfeeding should be discouraged as it requires monthly maternal and infant viral load follow-up for the duration of the breastfeeding period and for 2 months post-cessation of breastfeeding.

Infant testing during COVID-19

VERY LOW-RISK infant

Two weeks of zidovudine monotherapy post-exposure prophylaxis (PEP) is recommended if all the following criteria are met:

• The woman has been on combination antiretroviral therapy (cART) for longer than 10 weeks;

• Two documented maternal HIV viral loads <50 HIV RNA copies/mL during pregnancy at least 4 weeks apart;

• Maternal HIV viral load <50 HIV RNA copies/mL at or after 36 weeks.

Recommendation 1: Infant should be tested with polymerase chain reaction (PCR) at birth and at 8 weeks.
A third PCR test taking place post-COVID-19 is an acceptable alternative to standard of care.
If, however, parents prefer infant testing at 0, 6 and 12 weeks, this can continue if arranged in advance with the HIV clinic.

LOW-RISK infant

Extend PEP to 4 weeks of zidovudine monotherapy:

• If the criteria for VERY LOW RISK are not all fulfilled but maternal HIV viral load is <50 HIV RNA copies/mL at or after 36 weeks;

• If the infant is born prematurely (<34 weeks) but most recent maternal HIV viral load is <50 HIV RNA copies/mL.

Recommendation 2: Infant should be tested with PCR at birth and at 8 weeks.
A third PCR test taking place post-COVID-19 is an acceptable alternative to standard of care.
If, however, parents prefer infant testing at 0, 6 and 12 weeks, this can continue if arranged in advance with the HIV clinic.

HIGH-RISK infant

Use of triple combination PEP if maternal birth HIV viral load is known to be or likely to be >50 HIV RNA copies/mL on day of birth, if uncertainty about recent maternal adherence or if viral load is not known.

Recommendation 3: Continue usual BHIVA guidance on infant testing at 0, 6 and 12 weeks; this should continue and be arranged in advance with the HIV clinic.

For all infants

The final infant HIV antibody test for seroreversion should be deferred from the current guidance of 18–24 months until after 22 months to ensure antibody is waning, and even this should be only be done post-COVID-19.

For further information, please contact [email protected] or for media enquiries, please contact Jo Josh at [email protected] or +44 (0)7787 530922.