What information have the results of clinical trials provided about antiretroviral therapy (ART) for HIV infection during pregnancy?

Updated: Jul 26, 2021
  • Author: Madhu Chhanda Choudhary, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Answer

These clinical trials have provided the following guiding principles:

  • The probability of HIV transmission is directly correlated with the viral load, especially the viral load at the time of delivery.
  • Regardless of HIV viral load and CD4 count, all HIV-infected pregnant women should be offered antiretroviral therapy (ART) to reduce perinatal transmission.
  • Elective cesarean delivery reduces the risk of perinatal transmission and should be offered at week 38 if the viral load is likely to exceed 1000 copies/mL at delivery; there is no benefit if the viral load is less than 1000 copies/mL or when the procedure is done after rupture of membranes.
  • Combination ART is more effective than a single-drug regimen in reducing perinatal transmission.
  • Longer duration of antepartum antiretroviral prophylaxis is more effective than shorter duration.
  • Antiretroviral drugs reduce perinatal transmission by several methods, accounting for the recommendation for a combination antepartum, intrapartum, and infant ART.
  • In women who are already receiving ART, the regimen needs to be reviewed for its adequacy in controlling HIV, its teratogenic potential, its pharmacologic effects, and patient tolerance during pregnancy.
  • In the absence of antepartum ART, intrapartum antiretroviral drugs should be administered in combination with infant antiretroviral prophylaxis to reduce the risk of perinatal transmission.
  • Four weeks of zidovudine prophylaxis should be given to infants born to mothers with suppressed viremia during pregnancy. Presumptive HIV treatment with combination ART including 6 weeks of zidovudine should be administered to infants born to mothers who did not receive antepartum care or did not have a sustained viral response during pregnancy.
  • Breastfeeding is not recommended in women with HIV infection in the United States. [1]

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