HIV and Pregnancy

Key points

• With the increased incidence of HIV infection amongst the heterosexual population there are an increasing number of HIV positive women giving birth in the UK. In London the incidence may be as high as 0.4% of pregnant women.
• maternal antiretroviral therapy — ALL pregnant women/birthing parents living with HIV should be on ART, including elite controllers · if not already on treatment, a common regimen is tenofovir plus emtricitabine (or abacavir plus lamivudine) with a third agent, often dolutegravir.
• MODE OF DELIVERY is NOT universally caesarean (BHIVA pregnancy and postpartum guidelines 2025). PLANNED VAGINAL DELIVERY should be SUPPORTED where the HIV viral load is < 50 copies/mL, in the absence of obstetric contraindications. Viral load 50–399 copies/mL: caesarean may be recommended. Viral load 400 copies/mL or more: plan a CAESAREAN SECTION.
• neonatal antiretroviral therapy
• INFANT FEEDING is a supported CHOICE, not a universal instruction. BHIVA continues to RECOMMEND exclusive FORMULA feeding as the way to eliminate postnatal transmission in the UK. However, a parent who is virologically suppressed (viral load < 50 copies/mL) with good adherence and who CHOOSES to breast/chestfeed should be SUPPORTED to do so.
• If breast/chestfeeding: counsel on the ongoing LOW BUT NON-ZERO transmission risk even at viral load < 50 — U=U applies to SEXUAL transmission and cannot currently be extended to breastmilk. Give LIFELONG ART to the feeding parent, and monitor parent (HIV RNA) and infant (HIV DNA) MONTHLY during feeding and for 2 MONTHS after stopping.
• Infant post-natal prophylaxis: usually ZIDOVUDINE monotherapy for 2 weeks where maternal viral load is suppressed; three-drug prophylaxis where it is not. Infant HIV testing at birth, 4–6 weeks, 10–12 weeks, and around 18–24 months. Screening