Updated Perinatal Guidelines Released Today

The HHS Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission (the Panel) announced today the release of 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:

  • Preliminary data suggest that there is a possible increased risk of neural tube defects in infants born to women who were receiving dolutegravir at the time of conception. In response, the Panel has developed conservative, interim recommendations regarding the use of dolutegravir during pregnancy and for women who are trying to conceive. A number of sections across the guidelines were revised to include these interim recommendations.
  • A new table, Table 7, provides an overview of drug recommendations for pregnant women who have never received antiretroviral (ARV) drugs, who are currently receiving ARV drugs, who previously received antiretroviral therapy (ART) or ARV prophylaxis, or who are receiving ART that is not well tolerated and/or not resulting in virologic suppression. This table also includes recommendations for nonpregnant women who are trying to conceive.
  • In Recommendations for Use of Antiretroviral Drugs During Pregnancy, the Panel now recommends dolutegravir as a preferred integrase strand transfer inhibitor option after the first trimester of pregnancy; this designation is based on available pharmacokinetic, efficacy, and safety data. Cobicistat-boosted atazanavir, darunavir, and elvitegravir are now classified as not recommended for use in pregnancy. This is due to concerns about pharmacokinetic changes during the second and third trimesters that may increase the risk of virologic failure.
  • Zidovudine plus lamivudine plus raltegravir is now a recommended empiric HIV therapy option for neonates who are at a higher risk of perinatal HIV transmission. Information has been added to the Antiretroviral Management of Newborns with Perinatal HIV Exposure or Perinatal HIV section about the use of raltegravir in infants.
  • In Maternal HIV Testing and Identification of Perinatal HIV Exposure, a new bulleted recommendation was added to emphasize that partners of pregnant women should be encouraged to undergo HIV testing if their HIV status is unknown. The indications for third-trimester HIV retesting have been updated to include women who are incarcerated or who reside in states that require third-trimester testing.
  • A subsection was added to Transmission and Mode of Delivery about the timing of vaginal delivery.
  • In Diagnosis of HIV Infection in Infants and Children, the use of an assay that detects HIV non-B subtype viruses or Group O is now recommended for known or suspected maternal non-B subtype virus or Group O infections. The case definition for indeterminate HIV infection in children aged less than 18 months has also been added.
  • Reproductive Options for Couples in Which One or Both Partners are Living with HIV now includes guidance about when to pursue a workup for infertility for serodiscordant couples who are attempting to conceive via sexual intercourse without a condom.

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