Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Prenatal evaluation of the HIV-infected woman in resource-rich settings

Brenna Hughes, MD, MSc
Susan Cu-Uvin, MD
Section Editor
Lynne M Mofenson, MD
Deputy Editor
Allyson Bloom, MD


Comprehensive medical care of the HIV-infected pregnant woman is associated with favorable maternal health outcomes and low rates of perinatal HIV transmission.

This topic will review elements of prenatal care and counseling for the HIV-infected woman. In the United States the Department of Health and Human Services has published guidelines on the evaluation and management of HIV-infected pregnant women [1]. Our recommendations below are largely consistent with these guidelines.

The use of antiretroviral (ARV) medications during pregnancy, intrapartum care, and infant antiretroviral prophylaxis are discussed elsewhere. (See "Antiretroviral and intrapartum management of pregnant HIV-infected women and their infants in resource-rich settings".)


A thorough history and physical examination should be performed in the HIV-infected pregnant woman to see if there are health concerns in the mother, which may also affect the well-being of the fetus. Patients should be interviewed about any history of opportunistic infections, tuberculosis, sexually transmitted diseases (STDs), medication use (including over the counter drugs), immunization status, or substance abuse issues. Immunosuppressed women who report fevers and weight loss may have an underlying opportunistic infection, which may compromise maternal and fetal health (eg, tuberculosis).

The physical examination should be focused on assessing any signs of advanced HIV infection (eg, thrush or evidence of wasting) or signs of concomitant STDs (eg, genital ulcers or vaginal discharge). Since many HIV-infected patients are also at risk for viral hepatitis, a careful examination for stigmata of advanced liver disease (eg, hepatomegaly, splenomegaly, spider angiomata) is also indicated.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Oct 2017. | This topic last updated: Jul 27, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. http://aidsinfo.nih.gov/guidelines/html/3/perinatal-guidelines/0/ (Accessed on October 19, 2017).
  2. Burns DN, Landesman S, Muenz LR, et al. Cigarette smoking, premature rupture of membranes, and vertical transmission of HIV-1 among women with low CD4+ levels. J Acquir Immune Defic Syndr 1994; 7:718.
  3. Matheson PB, Thomas PA, Abrams EJ, et al. Heterosexual behavior during pregnancy and perinatal transmission of HIV-1. New York City Perinatal HIV Transmission Collaborative Study Group. AIDS 1996; 10:1249.
  4. Rodriguez EM, Mofenson LM, Chang BH, et al. Association of maternal drug use during pregnancy with maternal HIV culture positivity and perinatal HIV transmission. AIDS 1996; 10:273.
  5. Bulterys M, Landesman S, Burns DN, et al. Sexual behavior and injection drug use during pregnancy and vertical transmission of HIV-1. J Acquir Immune Defic Syndr Hum Retrovirol 1997; 15:76.
  6. Turner BJ, Hauck WW, Fanning TR, Markson LE. Cigarette smoking and maternal-child HIV transmission. J Acquir Immune Defic Syndr Hum Retrovirol 1997; 14:327.
  7. Landesman SH, Kalish LA, Burns DN, et al. Obstetrical factors and the transmission of human immunodeficiency virus type 1 from mother to child. The Women and Infants Transmission Study. N Engl J Med 1996; 334:1617.
  8. Mongelli M, Wilcox M, Gardosi J. Estimating the date of confinement: ultrasonographic biometry versus certain menstrual dates. Am J Obstet Gynecol 1996; 174:278.
  9. Neilson JP. Ultrasound for fetal assessment in early pregnancy. Cochrane Database Syst Rev 2000; :CD000182.
  10. Yang H, Kramer MS, Platt RW, et al. How does early ultrasound scan estimation of gestational age lead to higher rates of preterm birth? Am J Obstet Gynecol 2002; 186:433.
  11. Gale HB, Gitterman SR, Hoffman HJ, et al. Is frequent CD4+ T-lymphocyte count monitoring necessary for persons with counts >=300 cells/μL and HIV-1 suppression? Clin Infect Dis 2013; 56:1340.
  12. Tuomala RE, Kalish LA, Zorilla C, et al. Changes in total, CD4+, and CD8+ lymphocytes during pregnancy and 1 year postpartum in human immunodeficiency virus-infected women. The Women and Infants Transmission Study. Obstet Gynecol 1997; 89:967.
  13. Miotti PG, Liomba G, Dallabetta GA, et al. T lymphocyte subsets during and after pregnancy: analysis in human immunodeficiency virus type 1-infected and -uninfected Malawian mothers. J Infect Dis 1992; 165:1116.
  14. Mehta S, Manji KP, Young AM, et al. Nutritional indicators of adverse pregnancy outcomes and mother-to-child transmission of HIV among HIV-infected women. Am J Clin Nutr 2008; 87:1639.
  15. Polis CB, Shah SN, Johnson KE, Gupta A. Impact of maternal HIV coinfection on the vertical transmission of hepatitis C virus: a meta-analysis. Clin Infect Dis 2007; 44:1123.
  16. Centers for Disease Control and Prevention. Guidelines for vaccinating pregnant women, Hepatitis A. 2013. http://www.cdc.gov/vaccines/pubs/preg-guide.htm#hepa (Accessed on May 08, 2014).
  17. Elzi L, Schlegel M, Weber R, et al. Reducing tuberculosis incidence by tuberculin skin testing, preventive treatment, and antiretroviral therapy in an area of low tuberculosis transmission. Clin Infect Dis 2007; 44:94.
  18. Prevention and treatment of tuberculosis among patients infected with human immunodeficiency virus: principles of therapy and revised recommendations. Centers for Disease Control and Prevention. MMWR Recomm Rep 1998; 47:1.
  19. Mwapasa V, Rogerson SJ, Kwiek JJ, et al. Maternal syphilis infection is associated with increased risk of mother-to-child transmission of HIV in Malawi. AIDS 2006; 20:1869.
  20. ACOG practice bulletin. Perinatal viral and parasitic infections. Number 20, September 2000. (Replaces educational bulletin number 177, February 1993). American College of Obstetrics and Gynecologists. Int J Gynaecol Obstet 2002; 76:95.
  21. Fowler KB, Stagno S, Pass RF, et al. The outcome of congenital cytomegalovirus infection in relation to maternal antibody status. N Engl J Med 1992; 326:663.
  22. Kovacs A, Schluchter M, Easley K, et al. Cytomegalovirus infection and HIV-1 disease progression in infants born to HIV-1-infected women. Pediatric Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV Infection Study Group. N Engl J Med 1999; 341:77.
  23. Quinn TC, Piot P, McCormick JB, et al. Serologic and immunologic studies in patients with AIDS in North America and Africa. The potential role of infectious agents as cofactors in human immunodeficiency virus infection. JAMA 1987; 257:2617.
  24. Pickering LK, Baker CJ, Freed GL, et al. Immunization programs for infants, children, adolescents, and adults: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2009; 49:817.
  25. Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: Recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf (Accessed on July 10, 2017).
  26. Ford N, Shubber Z, Jao J, et al. Safety of cotrimoxazole in pregnancy: a systematic review and meta-analysis. J Acquir Immune Defic Syndr 2014; 66:512.
  27. US Food and Drug Administration. Safety communication: Oral fluconazole in pregnancy. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm497656.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery (Accessed on April 26, 2016).
  28. Mølgaard-Nielsen D, Svanström H, Melbye M, et al. Association between use of oral fluconazole during pregnancy and risk of spontaneous abortion and stillbirth. JAMA 2016; 315:58.
  29. Antiretroviral Pregnancy Registry Steering Committee (2012). Antiretroviral Pregnancy Registry Steering Committee. Antiretroviral pregnancy registry international interim report for 1 Jan 1989 - 31 January 2012. Wilmington, NC: Registry Coordinating Center; 2010. http://www.APRegistry.com (Accessed on July 16, 2012).
  30. Ekoukou D, Khuong-Josses MA, Ghibaudo N, et al. Amniocentesis in pregnant HIV-infected patients. Absence of mother-to-child viral transmission in a series of selected patients. Eur J Obstet Gynecol Reprod Biol 2008; 140:212.
  31. Mandelbrot L, Jasseron C, Ekoukou D, et al. Amniocentesis and mother-to-child human immunodeficiency virus transmission in the Agence Nationale de Recherches sur le SIDA et les Hépatites Virales French Perinatal Cohort. Am J Obstet Gynecol 2009; 200:160.e1.
  32. Coll O, Suy A, Hernandez S, et al. Prenatal diagnosis in human immunodeficiency virus-infected women: a new screening program for chromosomal anomalies. Am J Obstet Gynecol 2006; 194:192.
  33. Somigliana E, Bucceri AM, Tibaldi C, et al. Early invasive diagnostic techniques in pregnant women who are infected with the HIV: a multicenter case series. Am J Obstet Gynecol 2005; 193:437.
  34. Maiques V, García-Tejedor A, Perales A, et al. HIV detection in amniotic fluid samples. Amniocentesis can be performed in HIV pregnant women? Eur J Obstet Gynecol Reprod Biol 2003; 108:137.
  35. Shapiro RL, Holland DT, Capparelli E, et al. Antiretroviral concentrations in breast-feeding infants of women in Botswana receiving antiretroviral treatment. J Infect Dis 2005; 192:720.
  36. Colebunders R, Hodossy B, Burger D, et al. The effect of highly active antiretroviral treatment on viral load and antiretroviral drug levels in breast milk. AIDS 2005; 19:1912.
  37. Schneider S, Peltier A, Gras A, et al. Efavirenz in human breast milk, mothers', and newborns' plasma. J Acquir Immune Defic Syndr 2008; 48:450.
  38. Rezk NL, White N, Bridges AS, et al. Studies on antiretroviral drug concentrations in breast milk: validation of a liquid chromatography-tandem mass spectrometric method for the determination of 7 anti-human immunodeficiency virus medications. Ther Drug Monit 2008; 30:611.