Updated Perinatal Guidelines

Updated Perinatal Guidelines

Tuesday, July 31, 2012

Go to AIDSInfo to see the guidelines

Key updates to the guidelines include:

  • New recommendation on use of antiretroviral therapy (ART) for serodiscordant couples who want to conceive, with strength of the recommendation differing on the basis of the infected partner’s CD4-cell count.

  • Added discussion of the pre-exposure prophylaxis (PrEP) studies in heterosexual couples, with a new recommendation regarding PrEP in discordant couples who want to conceive.

  • Added discussion on benefit of therapy for reducing sexual transmission to discordant partners when viral suppression is maintained.

  • Reclassification of various antiretroviral (ARV) agents to the categories of Preferred Agents, Alternative Agents, or for Use in Special Circumstances.

  • Increased discussion on timing (that is, trimester) of initiation of ARV drugs in ARV-naive pregnant women. Discussion of continuation of efavirenz in women receiving efavirenz-based ART who present for antenatal care in the first trimester.

  • Addition of a new table: Table 7 – Results of Studies Assessing Association Between Antiretroviral Regimens and Preterm Delivery.

  • Discussion of use of intravenous (IV) zidovudine during labor and maternal viral load, with recommendation that IV zidovudine is needed only for women with HIV RNA ≥400 copies/mL (or unknown HIV RNA) near delivery.

  • Updated information and discussion concerning infant ARV prophylaxis in the context of the NICHD-HPTN 040 study.

  • New recommendations regarding postnatal care of the HIV-exposed neonate.