HIV News Alert
Updated HHS Perinatal Antiretroviral Treatment Guidelines Released
December 7, 2018: The HHS Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission (the Panel) is pleased to announce the release of the updated Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States
Key updates to the guidelines include the following:
• Preliminary data suggest that there is a possible increased risk of neural tube defects in infants born to women who were receiving dolutegravir at the time of conception. In response, the Panel has developed conservative, interim recommendations regarding the use of dolutegravir during pregnancy and for women who are trying to conceive. A number of sections across the guidelines were revised to include these interim recommendations.
• A new table, Table 7, provides an overview of drug recommendations for pregnant women who have never received antiretroviral (ARV) drugs, who are currently receiving ARV drugs, who previously received antiretroviral therapy (ART) or ARV prophylaxis, or who are receiving ART that is not well tolerated and/or not resulting in virologic suppression. This table also includes recommendations for nonpregnant women who are trying to conceive.
• In Recommendations for Use of Antiretroviral Drugs During Pregnancy, the Panel now recommends dolutegravir as a preferred integrase strand transfer inhibitor option after the first trimester of pregnancy; this designation is based on available pharmacokinetic, efficacy, and safety data. Cobicistat-boosted atazanavir, darunavir, and elvitegravir are now classified as not recommended for use in pregnancy. This is due to concerns about pharmacokinetic changes during the second and third trimesters that may increase the risk of virologic failure.
• Zidovudine plus lamivudine plus raltegravir is now a recommended empiric HIV therapy option for neonates who are at a higher risk of perinatal HIV transmission. Information has been added to the Antiretroviral Management of Newborns with Perinatal HIV Exposure or Perinatal HIV section about the use of raltegravir in infants.
• In Maternal HIV Testing and Identification of Perinatal HIV Exposure, a new bulleted recommendation was added to emphasize that partners of pregnant women should be encouraged to undergo HIV testing if their HIV status is unknown. The indications for third-trimester HIV retesting have been updated to include women who are incarcerated or who reside in states that require third-trimester testing.
• A subsection was added to Transmission and Mode of Delivery about the timing of vaginal delivery.
• In Diagnosis of HIV Infection in Infants and Children, the use of an assay that detects HIV non-B subtype viruses or Group O is now recommended for known or suspected maternal non-B subtype virus or Group O infections. The case definition for indeterminate HIV infection in children aged less than 18 months has also been added.
• Reproductive Options for Couples in Which One or Both Partners are Living with HIV now includes guidance about when to pursue a workup for infertility for serodiscordant couples who are attempting to conceive via sexual intercourse without a condom.
For a complete list of updates, please see What's New in the Guidelines. Additions and revisions are highlighted in yellow throughout the PDF version of the guidelines.
To view or download the guidelines, go to the Perinatal Guidlines section of AIDSinfo’s website. The guideline tables and recommendations can also be downloaded as separate PDF files.
December 11-14, 2018
The 2018 National Ryan White Conference on HIV Care and Treatment takes place next week just outside of Washington, DC, in Oxon Hill, Maryland. HIV.gov will be there, sharing coverage from the conference and offering social media technical assistance to attendees.
The biennial conference is sponsored and organized by the Health Resources and Services Administration’s (HRSA) HIV/AIDS Bureau (HAB), which administers the Ryan White HIV/AIDS Program (RWHAP). It is the largest national conference for comprehensive HIV care and treatment providers, RWHAP recipients, and other stakeholders. Over 4,000 participants are expected this year.
The 2018 conference theme, Catalyzing Success: Advancing Innovation. Leveraging Data. Ending the HIV Epidemic., recognizes the RWHAP’s commitment to the national goals for ending the HIV epidemic. These goals include:
• Decreasing new HIV infections
• Reducing HIV-related health disparities
• Improving access to HIV care and treatment without stigma and discrimination
• Achieving a more coordinated national response
Some of the HIV.gov team will be on hand to lend support to this important conference. We’ll provide daily coverage here on the blog and via Facebook Live interviews and social media updates for those not able to attend. For conference attendees, we’ll offer a Social Media Lab.
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