Index - 6 - 7 - 8/9 - 10/11/12 - 13 - 14 - 15 - 16 - 17 - 18/19 - 20/21 - 22/23
TREATMENT OF HIV PREGNANT WOMEN
Pregnant women should be monitored every month and as close as possible to the predicted delivery date.
Criteria for starting ART in pregnant women
(see different scenarios)		 Same as for non pregnant
Objective of treatment in pregnant women Full Plasma HIV RNA suppression by third trimester and specifically at time of delivery
Resistance testing Same as for non pregnant, i.e. before starting ART and in case of virological failure

SCENARIO

  1. Women becoming pregnant while already on ART

  2. Women becoming pregnant while treatment naïve and who fulfil the criteria (CD4) for initiation of ART

  3. Women becoming pregnant while treatment naïve and who do not fulfil the criteria (CD4) for initiation of ART

  4. Women whose follow up starts after W28 of pregnancy

 

  1. Maintain ART but switch drugs that are potentially teratogenic

  2. Start ART at start of 2nd trimester is optimal



  3. Start ART at start of W28 of pregnancy (at the latest 12 weeks before delivery); start earlier if high plasma viral load or risk of prematurity

  4. Start ART immediately
Antiretroviral regimen in pregnancy

Same as non pregnant,

  • except avoid EFV
  • NVP not to be initiated but continuation is possible if started before pregnancy
  • Among PI/r, prefer LPV/r or SQV/r or ATV/r
  • RAL, DRV/r: few data available in pregnant women
  • ZDV should be part of the regimen if possible
Drugs contra-indicated during pregnancy Efavirenz, ddI + d4T,Triple NRTI combinations
IV zidovudine during labour Benefit uncertain if Plasma HIV RNA < 50 c/ml
Single dose nevirapine during labour Not recommended
Caesarean section Benefit uncertain if Plasma HIV RNA < 50 c/ml at W34-36