Updated HHS Perinatal Guidelines Released

On 12/29/20, the HHS Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission released the updated Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States.

Key updates to the guidelines include the following:

  • The Panel has also added a new guidelines section, HIV Pre-Exposure Prophylaxis (PrEP) to Reduce the Risk of Acquiring HIV During Periconception, Antepartum, and Postpartum Periods. The Panel recommends that health care providers offer and promote PrEP to individuals who are at risk for HIV and are trying to conceive or are pregnant, postpartum, or breastfeeding. This section also encourages health care providers to register patients who became pregnant while receiving PrEP with the Antiretroviral Pregnancy Registry.
  • In the Monitoring of the Women and Fetus During Pregnancy section, information in the bulleted recommendations and the text is now summarized in a new table, Table 6. HIV-Related Laboratory Monitoring Schedule for Pregnant Women with HIV.
  • Intrapartum Care for Women with HIV has been revised, the former sections on Intrapartum Antiretroviral Therapy/Prophylaxis, Transmission and Mode of Delivery, and Other Intrapartum Management Considerations have been combined into a single section, and Table 7, Intrapartum Care and Recommended Interventions to Prevent Perinatal HIV Transmission for Women with HIV Based on Maternal HIV RNA at the Time of Delivery, has been added to provide easy access to information. In the new combined section, some of the Panel’s bulleted recommendations have been reorganized according to maternal HIV RNA near the time of delivery, which is defined as ≥34–36 weeks gestation or 4–6 weeks before delivery.
  • In Table 5. Situation-Specific Recommendations for Use of Antiretroviral Drugs, the Panel has updated the recommendations on the use ARV drugs in pregnant people and nonpregnant people who are trying to conceive based on data available as of December 2020.
  • The Panel recommends DTG as a Preferred (ARV) drug throughout pregnancy and now also recommends DTG as a Preferred ARV for women who are trying to conceive.
  • Lopinavir/ritonavir is now classified as Not Recommended Except in Special Circumstances, rather than as an Alternative ARV.
  • The Panel now recommends tenofovir alafenamide (TAF) as an Alternative nucleoside reverse transcriptase inhibitor for ARV therapy regimens.
  • The Panel strongly recommends that use of DTG and all ARV drugs be accompanied by appropriate counseling to allow patients and their health care providers to make informed decisions about treatment.

For a complete list of updates, see What's New in the Guidelines. Additions and revisions are highlighted in yellow throughout the PDF version of the guidelines.