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Infecção por vírus da imunodeficiência humana (HIV) na gestação

Última revisão: 6 Aug 2025
Última atualização: 23 Aug 2024

Resumo

Definition

History and exam

Key diagnostic factors

  • aumento do risco de infecção materna pelo vírus da imunodeficiência humana (HIV)
  • aumento do risco de transmissão de HIV perinatal
Full details

Other diagnostic factors

  • candidíase oral
  • aumento da dispneia
  • perda de peso
  • febre
  • mal-estar
  • linfadenopatia
  • exantema maculopapular que clareia com a pressão
Full details

Risk factors

  • compartilhamento de agulha com uso de drogas injetáveis
  • penetração vaginal receptiva sem proteção
  • penetração anal receptiva sem proteção
  • picada com agulha percutânea
  • infecções sexualmente transmissíveis (ISTs) e vaginose bacteriana
  • alta carga viral materna (transmissão perinatal)
  • ausência de terapia antirretroviral pré-natal materna (transmissão perinatal)
  • aleitamento materno em mães sem supressão viral (transmissão perinatal)
  • violência contra mulheres e meninas
  • penetração oral receptiva
  • penetração oral insertiva
  • múltiplos parceiros sexuais
  • baixa contagem materna de CD4 (transmissão perinatal)
Full details

Diagnostic tests

1st tests to order

  • ensaio de imunoadsorção enzimática (ELISA) com antígeno/anticorpo anti-HIV-1 (vírus da imunodeficiência humana-1)/HIV-2 materno
  • imunoensaio diferencial com anticorpo anti-HIV-1/HIV-2 materno
  • reação em cadeia da polimerase do ácido desoxirribonucleico (DNA) ou do ácido ribonucleico (RNA) do HIV neonatal
Full details

Tests to consider

  • Western blot para HIV-1
  • ensaio de imunofluorescência indireta para HIV-1
  • teste de ácido nucleico (NAT) do HIV-1
  • contagem de CD4
  • níveis plasmáticos de RNA do HIV (carga viral)
  • testes de função renal
  • testes da função hepática
  • teste de resistência a medicamentos
  • hemograma completo
  • rastreamento de glicose
  • ultrassonografia fetal
  • testes para coinfecção
Full details

Treatment algorithm

ACUTE

Gestantes infectadas por HIV-1: <38 semanas que não estejam em trabalho de parto (independentemente do nível de RNA do HIV)

gestantes infectadas pelo vírus da imunodeficiência humana-1 (HIV-1) com níveis de ácido ribonucleico (RNA) do HIV-1 >1000 cópias/mL: em 38 semanas ou em trabalho de parto

gestantes infectadas pelo vírus da imunodeficiência humana-1 (HIV-1) com níveis de ácido ribonucleico (RNA) do HIV-1 ≤1000 cópias/mL: em 38 semanas ou em trabalho de parto

lactentes nascidos de mães infectadas pelo vírus da imunodeficiência humana (HIV)

Contributors

Authors

Rachel K. Scott, MD, MPH, FACOG

Associate 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

MedStar Washington Hospital Center Department of Women’s and Infants’ Services

Washington

DC

Disclosures

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.

Acknowledgements

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.

Disclosures

ID, CB, and MK declare that they have no competing interests.

Peer reviewers

Aisha Sethi, MD

Assistant Professor of Medicine

Associate Residency Program Director

University of Chicago

Chicago

IL

Disclosures

AS declares that she has no competing interests.

Graham P. Taylor, MBChB, FRCP, FHEA

Reader in Communicable Diseases

Faculty of Medicine

Imperial College

London

UK

Disclosures

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.

References

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.

Key articles

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. Jan 2024 [internet publication].Full text

Reference articles

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

    • Mononucleose infecciosa
    • Toxoplasmose
    • Hepatite viral
    More Differentials
  • Guidelines

    • Recommendations for the use of antiretroviral drugs during pregnancy and interventions to reduce perinatal HIV transmission in the United States
    • Care of pregnant women living with HIV and interventions to reduce perinatal transmission
    More Guidelines
  • Patient information

    Infecção por vírus da imunodeficiência humana (HIV) na gestação

    More Patient information
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