All pregnant women should be tested for HIV infection as early as possible in pregnancy. Third trimester screening is recommended in high-risk patients, high incidence and prevalence communities, and in medical centers with a screen-positive rate of greater than 1 per 1,000.
HIV-1/HIV-2 antigen/antibody combination immunoassay is the preferred HIV screening test. It can be performed on blood or on oral fluid in the laboratory or as a rapid test. If the immunoassay is reactive, it must be followed by confirmatory testing with an HIV-1/HIV-2 antibody differentiation immunoassay.
A negative test does not preclude diagnosis, as antibody tests cannot exclude recent infection. Repeat testing 6 weeks after exposure is recommended.
Combination antiretroviral therapy (cART) should be initiated as early as possible in the pregnancy, or continued in women already on cART, to prevent mother-to-child transmission (MTCT) of HIV.
Scheduled cesarean delivery with zidovudine (AZT, ZDV) prophylaxis at 38 weeks’ gestation is recommended for women with HIV RNA levels >1000 copies/mL, and women with unknown viral load, for prevention of MTCT.
Breastfeeding is not recommended in resource-rich settings, secondary to the risk of MTCT of HIV through breast milk. Exclusive breastfeeding with maternal cART until 12 months is recommended in settings where bottle feeding is not feasible.
Human immunodeficiency virus (HIV) is a retrovirus that causes HIV by infecting CD4 T cells and can lead to acquired immunodeficiency syndrome (AIDS).  Pregnancy in women living with HIV is complicated not only by HIV infection itself but also by the medical and psychosocial comorbidities associated with HIV. HIV infection in pregnancy poses a threat to maternal immune health and can lead to perinatal transmission of HIV in utero, intrapartum, or through breastfeeding postpartum.
Assistant Professor of Obstetrics and Gynecology
Georgetown University School of Medicine
Scientific Director of Women’s Health Research
MedStar Health Research Institute
MedStar WHC Women's Center for Positive Living
MedStar Washington Hospital Center Department of Women’s and Infants’ Services
RKS declares that she has no competing interests.
Dr Rachel K. Scott would like to gratefully acknowledge Dr Isaac Delke, Dr Christina Bailey, and Dr Mettassebia Kano, the previous contributors to this monograph. ID, CB, and MK declare that they have no competing interests.
Assistant Professor of Medicine
Associate Residency Program Director
University of Chicago
AS declares that she has no competing interests.
Reader in Communicable Diseases
Faculty of Medicine
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.
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