HIV and Pregnancy

BHIVA guidelines on the management of HIV in pregnancy and the postpartum period 2025

Guidelines

All pregnant women should be offered HIV screening at booking visit (8-12 weeks).

ALL women on an effective ART regimen who get pregnant should continue their ART treatment​​​​​​.

If the patient not on ART → should start ART as soon as possible (by 24 weeks the very latest)
  • 1st choice regimen: tenofovir DX/emtricitabine + dolutegravir (if no renal or bone concerns)

  • CD4 count at baseline + each trimester + at delivery
  • Viral load 2-4 weeks after starting ART + every trimester + at 36 weeks + at delivery
  • LFTs with routine blood

Measure plasma viral load at 36 weeks and use that measurement to decide the mode of delivery.
  • If viral load <50 copies/mL → vaginal delivery can be supported
 
  • If viral load >50 copies/mL →
    • Planned (pre-labour) caesarean section to be considered from 38 weeks 
    • Zidovudine infusion throughout labour and/or delivery until cord clamping
      • Should be commenced 4 hours prior to planned Caesarean section

 

The women must deliver in a unit with on-site paediatric care to start neonatal PNPPost-natal prophylaxis within 4 hr.

Continue lifelong ART postpartum

PNPPost-natal prophylaxis to be started ASAP, latest within 4 hours.

Choice of PNP Post-natal prophylaxisdepends on the risk of acquiring HIV, low-risk features:
  • All viral load measurements 10 weeks prior delivery are <50 copies/mL
  • Maternal ART commenced at least 10 weeks prior delivery
  • At least 1 viral load measurement 6 weeks prior delivery
  • Good engagement from mother's end
 

Offer zidovudine monotherapy for 2 weeks

Offer triple therapy PNPPost-natal prophylaxis 
  • Nevirapine for 2 weeks
  • ​​​​​​​Zidovudine + lamivudine for 4 weeks

All women should be advised NOT to breastfeed.

Exclusive formula feeding is recommended.
Author: Adams Lau
Reviewer:
Last Edited: 10/07/25