Question | Discussion | References

Updated March 24, 2013

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

Authors: Alison C. Roxby, MD, MSc Christopher Behrens, MD Grace John-Stewart, MD, PhD

A 20-year-old pregnant East African woman at term presents to a rural primary health clinic in early labor. She has not received any antenatal care and her HIV status is unknown. A rapid test for HIV, administered in the labor ward, is positive. She is healthy and has no known medical problems. She is planning to breastfeed her baby; formula is not available in her village.

Which one of the following interventions is recommended for this woman in labor with a new diagnosis of HIV infection?

A She has presented too late for any meaningful and effective efforts to prevent HIV transmission to her child.
B She should be immediately transferred to a hospital for an urgent Cesarean section to reduce the risk of HIV transmission to her child. No antiretroviral therapy is indicated for her, but her infant should receive prophylaxis with daily oral nevirapine starting at birth and continued until one week after breastfeeding has stopped..
C A single oral dose of nevirapine should be given to her immediately, along with a dose of oral zidovudine plus lamivudine, with continuation of the zidovudine plus lamivudine for one week postpartum. Her infant should receive prophylaxis with daily oral nevirapine starting at birth and continued until one week after breastfeeding has stopped.
D Oral zidovudine plus lamivudine should be given to her immediately and continued for one week postpartum; her infant should receive oral zidovudine-lamivudine starting at birth and continued until one week after breastfeeding has stopped.