CDC Recommendations for ReducingPerinatal HIV Transmission

1. At 14 to 34 weeks of gestation, a CD4 count above 200 per uL and noprevious antiretroviral therapy: three-phase zidovudine (Retrovir) therapyshould be offered to the pregnant woman and to the infant after birth (seeTable 3).*

2. At more than 34 weeks of gestation: three-phase zidovudine therapyshould be offered to the pregnant woman and to the infant after birth.

3. With a CD4 counts below 200 per uL: three-phase zidovudine should beoffered for the woman's benefit.

4. With more than six months of any antiretroviral therapy before pregnancy:three-phase zidovudine therapy should be offered on a case-by-case basis.

5. For women who received no antiretroviral therapy during pregnancy andpresent in labor: zidovudine therapy should be offered intrapartum to themother and to the infant after delivery as the clinical situation permits.

6. For infants born after no zidovudine prophylaxis: zidovudine therapyshould be offered for the infant if therapy can be initiated within 24hours of birth.

CDC = Centers for Disease Control and Prevention; HIV = humanimmunodeficiency virus.

*_Implies no previous antiviral therapy has beenused.

Adapted from Recommendations of the U.S. Public Health Service Task Force onthe use of zidovudine to reduce perinatal transmission of humanimmunodeficiency virus. MMWR Morb Mortal Wkly Rep 1994;43(RR-11):1-20.

Perinatal Care of HIV-Infected Mothers and Their Infants

Antenatal surveillance

1. Perform standard prenatal baseline laboratory tests and Papanicolaou smears, plus CD4 counts,toxoplasmosis and cytomegalovirus titers, liver enzyme levels, a tuberculin test (purified proteinderivative) and a glucose-6-phosphate dehydrogenase (G6PD) level.7

2. Offer zidovudine (Retrovir) prophylaxis according to the guidelines formulated by the Centers forDisease Control and Prevention (see Table 4).37

3. Consider antenatal influenza, pneumococcal and hepatitis B immunizations (may wait until after the firsttrimester). 4 7

4. Perform a complete physical examination and a review. of systems during each trimester. 7 27

5. Maintain surveillance for HIV-related opportunistic infections based on CD4 staging; initiateprophylaxis as indicated. 7

6. Repeat sexually transmitted disease screening tests (rapid plasmin reagin test/VDRL test, gonorrheaculture and Chlamydia assay) and group B streptococcal culture in the third trimesters

7. If the pregnant woman is receiving zidovudine therapy, monitor the complete blood count and liverenzyme levels each month.37

8. Obtain a CD4 count each trimester if the count is under 600 per uL; repeat the CD4 count at six weeksand six months postpartum. 37

9. Discuss postpartum contraception and safe sexual practices. 7

Intrapartum management

1. Minimize internal fetal monitoring and fetal scalp sampling; fetal scalp lesions increase the risk ofexposure to maternal blood. 7 27 36

2. Wear double gloves and eye shields to protect against exposure to body fluids. 4 4, 7

3. Avoid episiotomy, vacuum extraction and the use of forceps. 7,27

4. At this time, cesarean sections have no specific HIV-related indications. 7,27

5. To avoid needle sticks, repair of all lacerations and episiotomies should be performed by the mostexperienced personnel available.

Postpartum management

1. Counsel the mother about the proper disposal of sanitary pads and the need for careful hand washingbefore she handles the infant.7

2. Circumcision is not specifically contraindicated.

3. Breast feeding should be discouraged in developed countries. 4,7 36

4. Provide routine postpartum and HIV-related care to the mother as indicated. 7

5. The child may require referral to a specialist familiar with the care of infants at risk for HIV infection. 37

HIV = human immunodeficiency virus.

Derived from references 4, 7, 27, 36 and 37.