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HIV and Pregnancy

BHIVA guidelines for the management of HIV in pregnancy and postpartum 2018 (2020 third interim update)

Guidelines

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

ALL women should continue ART in pregnancy.

If patient not on ART → must be started by 24 weeks
  • If viral load <100,000 → start in 2nd trimester
  • If viral load >100,000 or CD4 count <200 → start in 1st trimester

Monitoring:
  • 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 routien blood

The women must deliver in a unit with on-site paediatric care to start neonatal PEPPost-exposure prophylaxis within 4 hr.
  • If viral load <50 copies/mL at 36 weeks → vaginal delivery is an option
  • If viral load >50 copies/mL → pre-labour caesarean section + zidovudine infusion 4 hours before (mandatory if viral load >1,000)

Mother:
  • Continue ART

Baby:
  • If maternal viral load <50 copies/mL → zidovudine monotherapy for 2-4 weeks
  • If maternal viral load >50 copies/mL → triple therapy PEPPost-exposure prophylaxis for 4 weeks (zidovudine + lamivudine + nevirapine)
    • If HIV-2 → replace nevirapine with raltegravir

All women should be advised NOT to breastfeed.

References

Author: Adams Lau
Reviewer:
Last Edited: 12/04/25