Question | Discussion | References

Updated February 1, 2013

Prevention of Mother to Child Transmission of HIV (PMTCT) during Antenatal Care

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

A 21-year-old woman presents to a clinic in Lilongwe, Malawi for prenatal care. She is 22 weeks pregnant, according to her last menstrual period. As part of routine antenatal care, she is tested for HIV using a rapid testing protocol, and is found to be HIV positive. She feels well. Her partner is healthy and, as far as she knows, he has never previously been tested for HIV.

Which of the following statements reflects appropriate management of this asymptomatic woman with a new diagnosis of HIV in pregnancy?

A She should not be given efavirenz at any time during pregnancy given its risk of teratogenicity.
B A Cesarean section should be planned at delivery in order to reduce the risk of HIV transmission to her infant.
C Nevirapine should be avoided unless this woman's CD4 count is known to be below 500 cells/mm3.
D She should start triple antiretroviral therapy immediately and a CD4 count should be checked if possible.