What is included in peripartum treatment for women with HIV infection?

Updated: Apr 02, 2019
  • Author: Ashley T Peterson, MD; Chief Editor: Ronald M Ramus, MD  more...
  • Print
Answer

Answer

In any pregnant woman infected with HIV who presents in labor, every effort should be made to continue her ART regimen on schedule in the peripartum period as much as possible to provide maximal virologic effect and to minimize the chance of developing drug resistance. All HIV-infected women with HIV RNA >1,000 copies/mL (or unknown HIV RNA) near delivery should be administered IV zidovudine (ZDV) during labor, in addition to their regular antepartum regimen and regardless of mode of delivery. IV ZDV is no longer required for HIV-infected women receiving combination ART regimens who have HIV RNA ≤1,000 copies/mL near delivery. [18]

ZDV is given intravenously during labor at a dose of 2 mg/kg infused over 1 hour, followed by a continuous infusion of 1 mg/kg throughout labor. This regimen, along with maternal antepartum and infant zidovudine, reduced perinatal transmission by 66% overall. [18] If the patient is having a planned cesarean delivery, the IV infusion should begin 3 hours before the procedure. [28, 31]

Women with documented drug resistance to ZDV or whose antepartum regimen did not include ZDV should still be given the intravenous ZDV protocol during labor and delivery or before cesarean delivery. [31] Furthermore, the other antiretroviral agents must be continued on schedule throughout the intrapartum or preoperative period. Stavudine is the only agent that can antagonize ZDV and should be stopped prior to the IV infusion of ZDV. [28]

In patients attempting a vaginal delivery, amniotomy performed in the setting of ART and virologic suppression is not associated with increased risk of perinatal transmission and can be performed for standard obstetric indications.   Amniotomy in the setting of viremia, routine use of fetal scalp electrodes for fetal heart rate monitoring, operative delivery with vacuum devices or forceps and episiotomy are generally avoided given the potential increased risk of transmission.

ART is now recommended for all HIV-infected individuals to reduce the risk of disease progression and to prevent HIV sexual transmission.  Antepartum ART regimens in general should be continued postpartum, however decisions regarding continuation should be made in consultation with the patient and her HIV care provider.  Such decision-making should occur in the outpatient setting and careful documented before delivery given the immediate postpartum period poses its own unique challenges to medication adherence.


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!