Special considerations for the HIV-infected patient with preterm labor

It is essential that women admitted for PTL have a confidential review of maternal history and prenatal record for HIV serostatus. Combination ARV therapy should be continued during tocolysis of PTL and, if tocolysis fails, through delivery. Counseling and rapid HIV testing should be performed in the intrapartum or postnatal periods if the woman's serostatus has not been determined. Women identified as being HIV infected who are in labor should be treated with (1) ZDV in labor and for 6 weeks to the neonate, (2) NVP single dose to the mother in labor and single dose to the neonate, (3) ZDV-3TC in labor and to the neonate for 1 week, or (4) NVP (as above) and the ZDV regimen (as above). Cesarean delivery should be recommended to all women when the most recent viral load is greater than or equal to 1000 copies/mL or is unknown. Those charged with the care of HIV-infected pregnant women should make frequent use of the Public Health Service Website (http://www.aidsinfo.nih.gov), which provides a regularly updated, practical, and thorough guide to management of patients who have HIV.