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BHIVA guidelines on the management of HIV in pregnancy and postpartum 2018 (2019 interim update)

Introduction

The overall purpose of these guidelines is to provide guidance on best clinical practice in the treatment and management of women living with HIV in the UK during pregnancy and postpartum, and their infants. The scope includes guidance on the use of antiretroviral therapy (ART) both to prevent vertical transmission of HIV and for the welfare of the woman and her baby, guidance on mode of delivery and recommendations in specific patient populations where other factors need to be taken into consideration, such as co-infection with other agents.

The guidelines are aimed at clinical professionals directly involved with, and responsible for, the care of pregnant women living with HIV. The 2018 guidelines have identified significant developments that have either led to a change in recommendation or a change in the strength of recommendation. More detail has been added in areas of controversy, particularly breastfeeding. New data that simply support the existing data have not routinely been included in this revision. A new section on the postpartum management of women has been added. Of note, the term ‘HIV’ refers to HIV-1 throughout these guidelines, unless HIV-2 is specified.

The purpose of the 2019 interim review is to identify significant developments that would either lead to a change in recommendation or a change in the strength of recommendation. These changes and the supporting evidence are highlighted. More detail has been added in areas of controversy.

BHIVA guidelines on the management of HIV in pregnancy and postpartum 2018


Downloads

BHIVA guidelines on the management of HIV in pregnancy and postpartum 2018 (2019 interim update) NHS Evidence accredited provider


Additional information

Literature search strategies

Patient breastfeeding information leaflet 1

Patient breastfeeding information leaflet 2


Public consultation comments

The comments received during the public consultation can be found below. All comments were reviewed and discussed and the guidelines amended where appropriate.

Download the comments received by the BHIVA Secretariat during the web consultation process


Declaration of interests

Download the declaration of interests from writing group members


Writing group

Chair

  • Dr Yvonne Gilleece, Honorary Clinical Senior Lecturer and Consultant Physician in HIV and Genitourinary Medicine, Brighton and Sussex University Hospitals NHS Trust

Vice-chair

  • Dr Shema Tariq, Postdoctoral Clinical Research Fellow, University College London, and Honorary Consultant Physician in HIV, Central and North West London NHS Foundation Trust

Writing group members

  • Dr Alasdair Bamford, Consultant in Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London

  • Dr Sanjay Bhagani, Consultant Physician in Infectious Diseases, Royal Free Hospital NHS Trust, London

  • Dr Laura Byrne, Locum Consultant in HIV Medicine, St George’s University Hospitals NHS Foundation Trust, London

  • Dr Emily Clarke, Consultant in Genitourinary Medicine, Royal Liverpool and Broadgreen University Hospitals NHS Trust

  • Ms Polly Clayden, UK Community Advisory Board representative/HIV treatment advocates network

  • Dr Hermione Lyall, Clinical Director for Children’s Services and Consultant Paediatrician in Infectious Diseases, Imperial College Healthcare NHS Trust, London

  • Dr Rebecca Metcalfe, Consultant in Sexual Health and HIV Medicine, NHS Greater Glasgow and Clyde

  • Dr Adrian Palfreeman, Consultant in Genitourinary Medicine, University Hospitals of Leicester NHS Trust

  • Dr Luciana Rubinstein, Consultant in Genitourinary Medicine, London North West Healthcare University NHS Trust, London

  • Ms Sonali Sonecha, Lead Directorate Pharmacist HIV/GUM, Chelsea and Westminster Healthcare NHS Foundation Trust, London

  • Dr Lisa Thorley, UK Community Advisory Board representative

  • Dr Pat Tookey, Honorary Senior Lecturer and Co-Investigator National Study of HIV in Pregnancy and Childhood, UCL Great Ormond Street Institute of Child Health, London

  • Ms Jennifer Tosswill, Clinical Scientist, Viral Reference Department, Public Health England, London

  • Mr David Utting, Consultant Obstetrician and Gynaecologist, Brighton and Sussex University Hospitals NHS Trust

  • Dr Steven Welch, Consultant in Paediatric Infectious Diseases, Heart of England NHS Foundation Trust, Birmingham

  • Ms Alison Wright, Consultant Obstetrician and Gynaecologist, Royal Free Hospitals NHS Foundation Trust, London


Guidelines updates and date of next review

We aim to revise these guidelines by 2021. In the meantime, the writing group will confer at least annually to consider new information from high-quality studies and will issue revisions or updates should clinically important and relevant data become available.