Synopsis
Maintain maternal viral suppression through pregnancy and birth, select delivery and neonatal prophylaxis from viral load and acquisition timing, and prevent postnatal transmission through informed feeding care.
- Offer HIV testing early in every pregnancy and repeat in later pregnancy when ongoing exposure or clinical risk warrants it.
- Continue effective suppressive ART in someone already treated; avoid switching a stable regimen without a maternal, fetal or interaction reason.
- Start a potent complete ART regimen promptly after a new diagnosis, using resistance, hepatitis B, gestation and comorbidity to select drugs.
Key red flags
Acute HIV acquisition during pregnancy or breastfeeding produces high viraemia and a major transmission risk.
A reactive screen requires urgent confirmation, baseline viral load and rapid specialist ART while emotional and safeguarding support begins.
Investigation priorities
Confirm a reactive antenatal screen and detect acute infection during a serological window.
Management branches
HIV is newly confirmed or acute infection is suspected during pregnancy.
- Contact the specialist HIV maternity team the same day and obtain viral load, CD4, resistance, hepatitis, renal and liver specimens.
- Start a complete potent ART regimen promptly after interaction and gestation review rather than waiting for every result.
Key medicines
Pregnancy antiretroviral regimenUse the exact specialist-selected complete integrase-inhibitor-based or other recommended regimen daily, adjusted for resistance, hepatitis B, gestation, kidney function and interactions.
Intravenous zidovudine during labourGive 2 mg/kg intravenously over one hour, then 1 mg/kg/hour until delivery when the specialist high-viraemia or intrapartum protocol indicates.