A combination of antiretroviral medications should be taken as prescribed during pregnancy in order to achieve an undetectable viral load and reduce the risk of vertical transmission. A multi-drug regimen is the only therapy which has been shown to achieve effective and sustained viral suppression for those living with HIV. It is important to realize that certain medications are contraindicated during pregnancy and that some medications require alterations in dosing during pregnancy. For this reason, people living with HIV and contemplating pregnancy as well as those who become pregnant should have their drug regimen reviewed by an infectious disease specialist. People who are inadvertently exposed to certain contraindicated medications during pregnancy may require additional surveillance. Please contact the Illinois Perinatal HIV Hotline for additional information or specific questions.
FAQs
The Illinois Perinatal HIV Hotline recommends intravenous AZT to be given during labor and delivery (See Best Practices: Labor & Delivery Care for Pregnant People with HIV and Care of Infants with Perinatal Exposure to HIV). Ideally, this should be started at the onset of uterine contractions with a goal of completing at least a 3 hour course prior to delivery in order to achieve adequate maternal and neonatal serum levels. AZT is given as an intravenous 2mg/kg load infusion given over the first hour followed by 1mg/kg/hour intravenously until delivery. Other antiretroviral medications should be continued during labor to ensure that their normal antiretroviral regimen is uninterrupted.
The best decisions about route of delivery are made together between a patient and their doctor. Obstetric indications regarding previous pregnancies and the current pregnancy (non-HIV related) must be factored into this decision. The Department of Health and Human Services Perinatal Guidelines cover this topic. The general summary of these recommendations on route of delivery are:
Vaginal delivery is safe if viral load is less than 1000 copies/ml at 36 weeks of pregnancy and the patient reports recent good adherence with antiretroviral medications. Physicians delivering people living with HIV should avoid all invasive monitoring devices including fetal scalp electrodes. Every attempt should be made to delay artificial rupture of membranes. Instrumental vaginal delivery with forceps should be avoided due to the potential to introduce fetal trauma and potentially increase viral exposure.
C-Section delivery is recommended if the viral load is unknown or is greater than 1000 copies/ml at 36 weeks of pregnancy. In these instances, delivery should be scheduled for 38 weeks gestation prior to the onset of labor and spontaneous rupture of membranes in order to achieve maximum benefit.
The Perinatal HIV Prevention Act (410 ILCS 335/) aims to eliminate perinatal HIV transmission and serves as the legal basis for rapid HIV testing in Illinois. It was first passed in August 2003 as Public Act 93-566 and was amended in 2006 and 2007. The law was most recently amended in August 2017 by Public Act 100-0265 and mandates the following:
- Standardized and mandated counseling of all pregnant people.
- Opt-out HIV testing as early in pregnancy as possible.
- Repeat opt-out HIV testing during the third trimester, ideally by the 36th week of pregnancy (August 2017 amendment).
- Opt-out rapid HIV testing be offered on labor and delivery to people without a documented HIV test from the third trimester of the current pregnancy (August 2017 amendment).
- Mandatory rapid HIV testing of newborns to determine HIV-exposure if there is no documentation of maternal HIV testing during the third trimester of pregnancy or at delivery (June 2006/August 2017 amendments).
- Reporting of all preliminary positive rapid HIV tests on birthing parents and infants within 12 hours, but no later than 24 hours, of the test result to the 24/7 Illinois Perinatal HIV Hotline at 1-800-439-4079 to ensure medical consultation and linkage to case management (June 2006/August 2017 amendments).
- Documentation of HIV test results in prenatal, labor and delivery, and newborn pediatric charts.
- Hospitals submit monthly aggregate statistics that include the number of people who present with known positive HIV status, the number of pregnant people rapidly tested for HIV in L&D, the number of newborn infants rapidly tested for HIV, the number of preliminarily positive pregnant people and preliminarily HIV-exposed newborn infants identified and other information determined necessary.
- Hospitals report cases of perinatal HIV exposure of newborns.
According to the CDC, without treatment there is a one in four chance that a pregnant person will pass HIV to their newborn. With treatment, that risk can be reduced to less than 1 in 50. The Illinois law ensures that pregnant people are strongly encouraged to accept HIV testing and offered treatment if they are diagnosed with HIV.
The Perinatal Rapid Testing Implementation Initiative in Illinois (PRTII2) was established in 2004 to support hospital implementation of rapid HIV testing as mandated by the Perinatal HIV Prevention Act. The Illinois Department of Public Health funded this effort. Leadership was provided by Dr. Mardge Cohen, MD (Cook County Bureau of Health Services), Dr. Patricia Garcia, MD, MPH (Northwestern Memorial Hospital), Yolanda Olszewski, MSc, MPH (Cook County Bureau of Health Services) and Anne Statton (Pediatric AIDS Chicago Prevention Initiative). Today, ongoing technical assistance is available through the Mother and Child Alliance (formerly Pediatric AIDS Chicago Prevention Initiative - PACPI). Please contact us if you have specific questions about rapid HIV testing or require assistance.
The Illinois Department of Public Health (IDPH) must provide case management to pregnant people living with HIV and their newborns, maintain the 24-hour Illinois Perinatal HIV Hotline, and prepare an annual report on the implementation of the Act.
Providers must report, within 12 hours but no later than 24 hours of a test result, all pregnant people or newborns with preliminary positive rapid HIV test results to the 24-hour Illinois Perinatal HIV Hotline (800-439-4079). Hospitals must also report aggregate statistics monthly and inform parents of the importance of treatment to prevent HIV transmission to the newborn. Every healthcare facility caring for a newborn whose birth parent was diagnosed with HIV prior to labor and delivery must report a case of perinatal HIV exposure to the appropriate health department.
In Illinois, mandatory rapid HIV testing of newborns to determine exposure to HIV is required if there is no documentation of the birth parent's HIV test result from the third trimester of pregnancy or at delivery. This testing should be done as soon as medically possible and is mandated by law in the Perinatal HIV Prevention Act.
Ideally, the call should be made to the Hotline as soon as possible. By Illinois law, the call must be placed within 12 hours but no later than 24 hours of the test result.
