[HIV and pregnancy: 2013 guidelines from the French expert working group]

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Pharmacology

Context:

• Antiretroviral therapy (ART) has dramatically reduced mother-to-child HIV transmission (MTCT) to below 1% globally.
• French guidelines (2013) advocate for lifelong ART for women living with HIV, encompassing pre-conception, pregnancy, and postpartum periods.
• Managing HIV in pregnancy involves careful antiretroviral drug selection to balance maternal benefits with fetal safety, necessitating interdisciplinary collaboration.

Purpose:

• To outline current obstetric practices for managing pregnancy in women living with HIV under effective ART.
• To detail recommendations for antiretroviral drug selection, labor management, and infant prophylaxis.
• To emphasize the importance of viral load monitoring in guiding obstetric and neonatal care decisions.

Summary:

• When maternal viral load is suppressed (<50 copies/mL), obstetric care approaches that of HIV-negative women.
• Prophylactic cesarean delivery is reserved for viral loads >400 copies/mL late in pregnancy. Intravenous zidovudine during labor is indicated only under specific high-viral-load or complication scenarios.
• For premature rupture of membranes before 34 weeks, management is individualized, favoring continuation of pregnancy with appropriate interventions if maternal viral load is undetectable and no signs of chorioamnionitis are present.

Impact:

• Optimized obstetric care for HIV-positive pregnant women, leading to near-elimination of MTCT.
• Established protocols for infant prophylaxis, including standard zidovudine for one month and combination therapy for high-risk neonates.
• Long-term monitoring of children exposed perinatally to ART to assess HIV-free status and detect potential adverse effects.