Management of the Pregnant Woman Diagnosed with HIV Infection while in Labor

rgb(51,102,75)
Last updated June 10, 2014
Case Authors: 
Alison C. Roxby, MD, MSc
Senior Fellow, Infectious Diseases

International AIDS Research & Training Program
Christopher Behrens, MD
Clinical Assistant Professor
Department of Global Health, Family Medicine, and Medicine
University of Washington School of Medicine 
Grace John-Stewart, MD, PhD
Professor of Medicine
Allergy and Infectious Diseases / 
International AIDS Research & Training Program, Global Health
Adjunct Professor,
Department of Epidemiology, International AIDS Research and Training Program
Learning Objectives: 
  1. Discuss the appropriate management of women diagnosed with HIV while in labor in resource-limited settings.
  2. Describe World Health Organization (WHO) guidelines for prophylaxis to prevent infant HIV infection in resource-limited settings.

Display Group

References
  1. World Health Organization (WHO). Global HIV/AIDS response: epidemic update and health sector progress towards universal access: progress report 2011. 2011.  
  2. World Health Organization (WHO). Toward universal access: scaling up priority HIV/AIDS interventions in the health sector, 2010.
  3. Moodley D, Esterhuizen T, Reddy L, et al. Incident HIV infection in pregnant and lactating women and its effect on mother-to-child transmission in South Africa. J Infect Dis. 2011;203:1231-4.
  4. Mugo NR, Heffron R, Donnell D, et al. Increased risk of HIV-1 transmission in pregnancy: a prospective study among African HIV-1-serodiscordant couples. AIDS. 2011;25:1887-95.
  5. Gray RH, Li X, Kigozi G, et al. Increased risk of incident HIV during pregnancy in Rakai, Uganda: a prospective study. Lancet. 2005;366:1182-8.
  6. Kinuthia J, Kiarie JN, Farquhar C, et al. Cofactors for HIV-1 incidence during pregnancy and postpartum period. Curr HIV Res. 2010;8:510-4.
  7. Pai NP, Barick R, Tulsky JP, et al. Impact of round-the-clock, rapid oral fluid HIV testing of women in labor in rural India. PLoS Med. 2008;5:e92.
  8. Theron GB, Shapiro DE, Van Dyke R, et al. Rapid intrapartum or postpartum HIV testing at a midwife obstetric unit and a district hospital in South Africa. Int J Gynaecol Obstet. 2011;113:44-9.
  9. Kongnyuy EJ, Mbu ER, Mbopi-Keou FX, et al. Acceptability of intrapartum HIV counselling and testing in Cameroon. BMC Pregnancy Childbirth. 2009;9:9.
  10. World Health Organization (WHO). Delivering HIV test results and messages for re-testing and counselling in adults. 2010.
  11. World Health Organization (WHO). Programmatic update. Use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants. April 2012.  
  12. McIntyre JA, Hopley M, Moodley D, et al. Efficacy of short-course AZT plus 3TC to reduce nevirapine resistance in the prevention of mother-to-child HIV transmission: a randomized clinical trial. PLoS Med. 2009;6:e1000172.
  13. Chasela CS, Hudgens MG, Jamieson DJ, et al. Maternal or infant antiretroviral drugs to reduce HIV-1 transmission. N Engl J Med. 2010;362:2271-81.
  14. Mbori-Ngacha D, Nduati R, John G, et al. Morbidity and mortality in breastfed and formula-fed infants of HIV-1-infected women: A randomized clinical trial. JAMA. 2001;286:2413-20.
  15. Thior I, Lockman S, Smeaton LM, et al. Breastfeeding plus infant zidovudine prophylaxis for 6 months vs formula feeding plus infant zidovudine for 1 month to reduce mother-to-child HIV transmission in Botswana: a randomized trial: the Mashi Study. JAMA. 2006;296:794-805.
  16. Shapiro RL, Lockman S, Kim S, et al. Infant morbidity, mortality, and breast milk immunologic profiles among breast-feeding HIV-infected and HIV-uninfected women in Botswana. J Infect Dis. 2007;196:562-9.
  17. . Elective caesarean-section versus vaginal delivery in prevention of vertical HIV-1 transmission: a randomised clinical trial. Lancet. 1999;353:1035-9.
  18. . The mode of delivery and the risk of vertical transmission of human immunodeficiency virus type 1--a meta-analysis of 15 prospective cohort studies. The International Perinatal HIV Group. N Engl J Med. 1999;340:977-87.
  19. Read JS, Newell MK. Efficacy and safety of cesarean delivery for prevention of mother-to-child transmission of HIV-1. Cochrane Database Syst Rev. 2005;:CD005479.
  20. Jackson JB, Musoke P, Fleming T, et al. Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: 18-month follow-up of the HIVNET 012 randomised trial. Lancet. 2003;362:859-68.