UK Guidelines on the Management of HIV infection in Pregnant Women (2008) published
These BHIVA guidelines for patients treated in the UK have now been updated and changes from the 2005 guidelines include:
- A greater range of clinical scenarios to include more consideration of adverse obstetric events, especially prematurity. This reflects the nature and volume of calls to the Writing Committee from fellow clinicians.
- Clearer recommendations regarding documentation of antenatal HIV testing, consideration to be given to repeat testing of women noted to be at continuing higher risk of HIV acquisition and advice to recommend near-patient HIV testing for untested women in labour.
- A further reduction in detail on teratogenicity, as this is better covered by reference to the Antiretroviral Pregnancy Registry.
- There are few substantive changes to the recommendations on the use of individual antiretroviral therapies. The option of zidovudine monotherapy plus pre-labour Caesarean section (PLCS) for selected women is supported by new data from the UK and Ireland cohort.
- There is more detail in the obstetric management section, reflecting the greater diversity of clinical situations being encountered, in part as a result of more women choosing to take short-term antiretroviral therapy (START) and try for an elective vaginal delivery. Data from two large European cohorts provide support for planning a vaginal delivery if HIV is undetectable on HAART.
- The recommendations for infant feeding in the UK remain unchanged.