BHIVA pregnancy guidelines: 2014 interim update
Polly Clayden, HIV i-Base
The British HIV Association guidelines for the management of HIV infection in pregnant women 2012 have been reviewed and updated May 2014.
The purpose of the 2014 interim review was to look at developments that led to either a change in recommendation or a change in the strength of the existing recommendation. The changes and the supporting evidence are highlighted in yellow.
There have been no major changes in recommendations and the updates are summarised as follows:
- The prevalence data from the UK have been updated.
- Safety: new data on efavirenz and raltegravir.
- Prescribing: darunavir updated.
- Resistance: data on mutations associated with the use of AZT monotherapy added; 21 days’ antiretroviral cover is recommended to prevent mutations following single-dose nevirapine.
- IV AZT: guidance refined to include all viral loads >1000 rather than 10 000 copies/mL.
- Hepatitis: information added on telaprevir and boceprevir.
- Mode of delivery: new data on transmission rates by mode of delivery at low viral load (50-399 copies/mL) added, strengthening the evidence for the existing recommendation to consider planned Caesarean section at these levels.
- Infant diagnostic section has been updated. No other change to paediatric section including infant feeding advice.
The guidelines will be fully updated and revised in 2017. The writing group will continue to look at new information from high-quality studies and amendments made to the current recommendations before this date where they consider this be clinically important.
British HIV Association guidelines for the management of HIV infection in pregnant women 2012 (2014 interim review)