Pre-Labor HIV Prophylaxis Recommendations

Antiretroviral Regimen Selection

The American College of Obstetricians and Gynecologists recommends that HAART (highly active antiretroviral therapy) be initiated after the first trimester in HIV-infected pregnant women who have not received prior therapy, ideally containing zidovudine, and continued through labor with intravenous zidovudine during delivery 1, 2
For HIV-infected pregnant women, the American College of Obstetricians and Gynecologists suggests continuing the HAART regimen during the intrapartum period with zidovudine given as continuous infusion during labor 1, 2
The Centers for Disease Control and Prevention recommends that nevirapine should be used with caution in women with CD4 counts >250/mm³ due to risk of severe hepatic toxicity 2
The American College of Obstetricians and Gynecologists recommends that elective cesarean delivery should be considered if plasma HIV RNA remains >1000 copies/mL at 34-36 weeks gestation 1, 2

The Centers for Disease Control and Prevention recommends intravenous zidovudine given as continuous infusion during labor for women who present in labor with no prior antiretroviral therapy 3, 4
The Centers for Disease Control and Prevention suggests single-dose nevirapine (200 mg) at onset of labor for women who present in labor with no prior antiretroviral therapy 3, 4, 5

The American Academy of Pediatrics recommends zidovudine for 6 weeks for infants born to mothers who received adequate antenatal antiretroviral therapy 1, 2, 6
The Centers for Disease Control and Prevention recommends either single-dose nevirapine (2 mg/kg) at birth PLUS zidovudine for 6 weeks, or zidovudine alone for 6 weeks for infants born to mothers who received no antiretroviral therapy before or during labor 3, 5, 6

The American College of Obstetricians and Gynecologists states that zidovudine remains the mainstay of perinatal prevention efforts and should be included in antiretroviral regimens for pregnant women whenever possible 1
The Centers for Disease Control and Prevention reports that the risk of vertical transmission is significantly reduced with appropriate antiretroviral prophylaxis, with transmission rates declining from 25.5% to 8.3% with zidovudine prophylaxis alone 7, 8
The Centers for Disease Control and Prevention recommends that elective cesarean delivery before onset of labor and membrane rupture can further reduce transmission risk by approximately 50% in women with HIV RNA >1000 copies/mL 8, 9

The American College of Obstetricians and Gynecologists recommends evaluating the need for continued maternal therapy after delivery 2
The American College of Obstetricians and Gynecologists suggests that if therapy is discontinued after delivery and the regimen included drugs with long half-lives, consider continuing the nucleoside analogue drugs for 3-7 days after stopping the NNRTI to reduce the risk of developing resistance 2
The Centers for Disease Control and Prevention recommends that breastfeeding is not recommended for HIV-infected women in resource-rich settings like the United States 8

The American College of Obstetricians and Gynecologists recommends closely monitoring liver function, particularly in those with CD4 counts >250/mm³, for women receiving nevirapine 2