HIV in pregnancy

Обзор 
Теория 
Диагноз 
Лечение 
Последующее наблюдение 
Источники 

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Последний просмотренный: 7 Mar 2026

Last updated: 25 Sep 2025

HIV in pregnancy not only poses a threat to maternal immune health, but can lead to transmission of HIV in utero, intrapartum, or through breast-feeding postpartum.

All pregnant women should be tested for HIV as early as possible in pregnancy. Repeat testing is recommended in the third trimester for pregnant women with initial negative tests who have high potential HIV exposure, live in an area with a high HIV prevalence, or receive care at a facility with a high HIV incidence.

HIV-exposed infants should be tested for HIV at birth and seek specialty care for follow-up testing and treatment.

All pregnant women with HIV should receive antiretroviral therapy (ART), as early as possible in the pregnancy, regardless of CD4 count or viral load. ART should be prescribed continuously during the antepartum, intrapartum, and postpartum periods, as well as antiretroviral prophylaxis for the neonate.

Evidence-based, patient-centered counseling regarding breast-feeding and replacement feeding is recommended to inform shared decision-making.

Определение

HIV is caused by a retrovirus that infects CD4 T cells and can lead to acquired immunodeficiency syndrome.[1] Pregnancy in women with HIV is complicated not only by the infection itself but also by the medical and psychosocial comorbidities associated with HIV.

This topic focuses on the diagnosis and initial management of pregnant women with HIV-1 infection. See Overview of HIV for other available HIV topics.

Анамнез и осмотр

Ключевые диагностические факторы

increased risk of maternal HIV acquisition
increased risk of perinatal HIV transmission

Полная информация

Другие диагностические факторы

oral candidiasis
increasing dyspnea
weight loss
fever
malaise
lymphadenopathy
maculopapular blanching rash

Полная информация

Факторы риска

people who inject drugs
unprotected penile-vaginal intercourse
unprotected anal intercourse
percutaneous needle stick injury
coinfection with other sexually transmitted infections (STIs) or bacterial vaginosis
high maternal viral load (perinatal transmission)
absence of prenatal maternal antiretroviral therapy (perinatal transmission)
breast-feeding in mothers without viral suppression (perinatal transmission)
violence against women and girls
receptive oral intercourse
insertive oral intercourse
multiple sexual partners
low maternal CD4 count (perinatal transmission)
cosmetic injection procedures

Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

maternal HIV-1/HIV-2 antigen/antibody enzyme-linked immunosorbent assay (ELISA)
maternal HIV-1/HIV-2 antibody differentiation immunoassay
infant HIV DNA or RNA polymerase chain reaction (PCR)

Полная информация

Исследования, проведение которых нужно рассмотреть

HIV-1 western blot
HIV-1 indirect immunofluorescence assay (IFA)
HIV-1 nucleic acid test (NAT)
CD4 count
plasma HIV RNA levels (viral load)
renal function tests
liver function tests (LFTs)
drug resistance tests
complete blood count
glucose screening
fetal ultrasound
tests for coinfections

Полная информация

Алгоритм лечения

Острый

pregnant women: <38 weeks not in labor (regardless of HIV RNA level)

pregnant women with HIV RNA levels >1000 copies/mL: at 38 weeks or in labor

pregnant women with HIV RNA levels ≤1000 copies/mL: at 38 weeks or in labor

infant with in utero or intrapartum HIV exposure

Составители

Авторы

Anna Powell, MD

Assistant Professor

Johns Hopkins University School of Medicine

Gynecology and Obstetrics

Baltimore

Раскрытие информации

AP declares that she has been paid for consultancy work with Cepheid in the past and receives royalties for authorship from UpToDate.

Выражение благодарностей

Dr Anna Powell would like to gratefully acknowledge Dr Rachel K. Scott, Dr Isaac Delke, Dr Christina Bailey, and Dr Mettassebia Kano, the previous contributors to this topic.

Раскрытие информации

RKS declares that she has participated in an advisory meeting for ViiV Healthcare and has received research funding from ViiV, managed by MedStar Health Institute. ID, CB, and MK declare that they have no competing interests.

Рецензенты

Aisha Sethi, MD

Assistant Professor of Medicine

Associate Residency Program Director

University of Chicago

Chicago

Раскрытие информации

AS declares that she has no competing interests.

Graham P. Taylor, MBChB, FRCP, FHEA

Reader in Communicable Diseases

Faculty of Medicine

Imperial College

London

Раскрытие информации

GPT has been reimbursed by various pharmaceutical companies for attending conferences, lecturing, and consulting, and has been chief investigator of investigator-initiated industry-funded research on HIV and pregnancy.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission. Recommendations for the use of antiretroviral drugs during pregnancy and interventions to reduce perinatal HIV transmission in the United States. Jun 2025 [internet publication].Полный текст

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Отличия
- Infectious mononucleosis
- Toxoplasmosis
- Viral hepatitis
Больше Отличия
Рекомендации
- Recommendations for the use of antiretroviral drugs during pregnancy and interventions to reduce perinatal HIV transmission in the United States
- CDC Yellow Book: health information for international travel - travelers with HIV
Больше Рекомендации
Лифлеты для пациента
HIV infection in pregnancy
Больше Лифлеты для пациента
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Использование этого контента попадает под действие нашего заявления об отказе от ответственности

HIV in pregnancy

Резюме

Определение

Анамнез и осмотр

Ключевые диагностические факторы

Другие диагностические факторы

Факторы риска

Диагностические исследования

Исследования, которые показаны в первую очередь

Исследования, проведение которых нужно рассмотреть

Алгоритм лечения

pregnant women: <38 weeks not in labor (regardless of HIV RNA level)

pregnant women with HIV RNA levels >1000 copies/mL: at 38 weeks or in labor

pregnant women with HIV RNA levels ≤1000 copies/mL: at 38 weeks or in labor

infant with in utero or intrapartum HIV exposure

Составители

Авторы

Anna Powell, MD

Раскрытие информации

Выражение благодарностей

Раскрытие информации

Рецензенты

Aisha Sethi, MD

Раскрытие информации

Graham P. Taylor, MBChB, FRCP, FHEA

Раскрытие информации

Peer reviewer acknowledgements

Disclosures

Список литературы

Основные статьи

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Отличия

Рекомендации

Лифлеты для пациента

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись, чтобы получить полноценный доступ к BMJ Best Practice