Draft BHIVA pregnancy guidelines (2014) online for comment
BHIVA guidelines for the management of HIV infection in pregnant women (2014 interim review) have been posted online in draft format for comment.
The guidelines aim to provide guidance on best clinical practice in the treatment and management of HIV positive pregnant women in the UK.
The purpose of the 2014 interim review is to identify significant developments that would either lead to a change in recommendation or a change in the strength of recommendation. These changes and the supporting evidence are highlighted. More detail has been added in areas of controversy. New data that simply support the existing data have not routinely been included in this revision. For the interim review conference abstracts and publications since September 2011 until end July 2013 were considered.
Summary of interim review:
- There have been no major changes in recommendation.
- The prevalence data from the UK have been updated.
- Safety: New data on efavirenz and raltegravir.
- Resistance: Data on mutations associated with the use of zidovudine monotherapy added. 21 days ARV cover advocated to prevent mutations following single dose nevirapine.
- IV zidovudine: Guidance refined to include all VL > 1000 rather than 10,000 HIV RNA copies/ml plasma.
- 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) added strengthening the evidence for the existing recommendation to consider PLCS at these viral loads.
- Infant diagnostic section has been updated. No other change to paediatric section including infant feeding advice.
The Pregnancy Guidelines Writing Group is grateful for all comments, which will be reviewed before publication.