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 are known to be at risk of acquiring HIV.
HIV-exposed infants should be tested for HIV infection at birth and 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 administered during the antepartum, intrapartum, and postpartum periods, as well as prophylaxis treatment to the neonate.
Breast-feeding is not recommended in resource-rich settings unless replacement feeding is not possible or feasible.
Human immunodeficiency virus (HIV) is a retrovirus that causes HIV infection 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 breast-feeding postpartum.
History and exam
- needle-sharing with injection drug use
- receptive penile-vaginal intercourse
- unprotected receptive anal intercourse
- percutaneous needle stick
- sexually transmitted infections (STIs) and bacterial vaginosis
- high maternal viral load (perinatal transmission)
- absence of prenatal maternal antiretroviral therapy (perinatal transmission)
- breast-feeding (perinatal transmission)
- violence against women and girls
- receptive oral intercourse
- insertive oral intercourse
- multiple sexual partners
- low maternal CD4 count (perinatal transmission)
- 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)
- tests for coinfections
- drug resistance test (genotyping)
- complete blood count
- glucose screening
- fetal ultrasound
Rachel K. Scott, MD, MPH, FACOG
Assistant Professor of Obstetrics and Gynecology
Georgetown University School of Medicine
Scientific Director of Women’s Health Research
MedStar Health Research Institute
Associate Chair for Research and Director
Women's Center for Positive Living
MedStar Washington Hospital Center Department of Women’s and Infants’ Services
RKS declares that she is a principal investigator on a Gilead Investigator Sponsored Research Award through MedStar Health Research Institute.
Dr Rachel K. Scott would like to gratefully acknowledge Dr Isaac Delke, Dr Christina Bailey, and Dr Mettassebia Kano, the previous contributors to this topic.
ID, CB, and MK declare that they have no competing interests.
Aisha Sethi, MD
Assistant Professor of Medicine
Associate Residency Program Director
University of Chicago
AS declares that she has no competing interests.
Graham P. Taylor, MBChB, FRCP, FHEA
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.
Recommendations for the use of antiretroviral drugs in pregnant women with HIV infection and interventions to reduce perinatal HIV transmission in the United States external link opens in a new window
Update to U.S. Medical Eligibility Criteria for contraceptive use, 2016: updated recommendations for the use of contraception among women at high risk for HIV infection external link opens in a new windowMore guidelines
Use of this content is subject to our disclaimer