Overview
HIV in Pregnancy: Prevention of Vertical Transmission
Screening: Universal opt out HIV testing at first prenatal visit + repeat in 3rd trimester in high risk areas Vertical transmission routes: 1.
Screening: Universal opt-out HIV testing at first prenatal visit + repeat in 3rd trimester in high-risk areas Vertical transmission routes: 1. Transplacental (in utero — primarily in 3rd trimester) 2. Intrapartum (most common route — 50–80% of transmissions) 3. Postpartum (breastfeeding — risk 14–22% without intervention) Goal: Undetectable viral load (<50 copies/mL) by delivery — reduces transmission to <1% Antiretroviral therapy (ART): - Start ART immediately after diagnosis in pregnancy (regardless of CD4 or VL) - Continue throughout pregnancy - Preferred regimens: tenofovir + emtricitabine (NRTI backbone) + raltegravir (integrase inhibitor) or dolutegravir Delivery planning: - Viral load <50 copies/mL on a recent result with consistent therapy: vaginal delivery is generally appropriate - Viral load approximately ≥400 copies/mL, unknown status, or inadequate adherence: consider scheduled caesarean birth near 38 weeks - Rupture of membranes: cesarean delivery if VL elevated; if low and membranes just ruptured → vaginal delivery may proceed - Avoid scalp electrode, IUPC, fetal blood sampling (invasive intrapartum procedures increase transmission risk) Zidovudine (ZDV/AZT) intrapartum: - IV ZDV during labor: still recommended for VL >1,000 copies/mL or unknown...