The Writing Group drew up a list of questions reflecting day-to-day practice and queries. It was acknowledged that the level of evidence for many of these topics was poor but recognized that there was a need to provide guidance. These guidelines have expanded on all areas relevant to the clinical care of HIV-positive pregnant women. The guidelines are intended to inform and aid healthcare workers in the management of pregnant women with HIV. They are not intended to be prescriptive or restrictive and it is recognized that situations will arise where the optimum management may deviate from these recommendations and new data will emerge to better inform practice. A particular focus has been
obstetric management. An increasing number of women are aiming for and achieving a vaginal delivery but the rate of emergency Caesarean sections has increased. It is hoped that the
recommendations contained within ABT-888 in vitro these guidelines will enable a further increase in the proportion of vaginal deliveries and a reduction in the number of emergency Caesarean sections. Linked to this is the proposed starting gestation for women temporarily taking combination antiretroviral therapy (cART) in pregnancy, which has been brought forward depending PI3K activation on baseline viral load. It is anticipated that this will result in a larger proportion of women achieving a viral load of < 50 HIV RNA copies/mL by 36 weeks' gestation, thereby allowing them to plan for a vaginal delivery. Additional
guidance has been provided with regard to conception on cART, the choice of specific drugs or drug classes and the management of women with hepatitis B virus or hepatitis C virus co-infection. For the first time these guidelines have addressed the issue of continuation of cART post delivery in women with a baseline CD4 cell count of more than 350 cells/μL. The paediatric section provides further guidance on infant post-exposure prophylaxis (PEP), drug dosing and safety. It is clear that there exists an urgent need for paediatric syrup preparations for a wider variety of antiretroviral drugs because the current options, particularly in the case of maternal viral resistance, are limited. In key areas, the National Florfenicol Study of HIV in Pregnancy and Childhood (NSHPC) informs the management of HIV in pregnancy through comprehensive data collection, collation and analysis, and the need to interrogate the data continues as practice changes. Prevalence of HIV infection amongst women giving birth in the UK was monitored through an unlinked anonymous survey based on residual neonatal dried blood spots until 2013, when it was discontinued. This survey was in place in London from 1988, other selected English regions from 1990, and Scotland between 1990 and 2008. It provided an estimate of overall HIV prevalence in women giving birth regardless of whether or not they had been diagnosed.