HIV screening in pregnancy

Question 1

Screening and HIV

Answer 1

• Sexual health screening is recommended for pregnant women newly diagnosed with HIV
• For HIV-positive women already engaged in HIV care who become pregnant sexual health screening is suggested.
• Genital tract infections should be treated according to guidelines.

Question 2

Laboratory monitoring of HIV-positive pregnant women

Answer 2

• Newly diagnosed HIV-positive pregnant women do not require any additional baseline investigations
• In women who either conceive on cART or who do not require cART for their own health there should be a minimum of one CD4 cell count at baseline and one at delivery
• In women who commence cART in pregnancy HIV viral load should be performed 2–4 weeks after commencing cART, at least once every trimester, at 36 weeks and at delivery
• In women commencing cART in pregnancy liver function tests should be performed as per routine initiation of cART and then at each antenatal visit

Question 3

If a woman who has initiated cART during pregnancy has not achieved a plasma viral load of

Answer 3

• Review adherence and concomitant medication
• Perform resistance test if appropriate
• Consider therapeutic drug monitoring (TDM)
• Optimize to best regimen
• Consider intensification