With the increased incidence of HIV infection amongst the heterosexual population there are an increasing number of HIV positive women giving birth in the UK. In London the incidence may be as high as 0.4% of pregnant women. The aim of treating HIV positive women during pregnancy is to minimise harm to both the mother and fetus, and to reduce the chance of vertical transmission.

Factors which reduce vertical transmission (from 25-30% to 2%)

• maternal antiretroviral therapy
• mode of delivery (caesarean section)
• neonatal antiretroviral therapy
• infant feeding (bottle feeding)

Screening

• NICE guidelines recommend offering HIV screening to all pregnant women

Antiretroviral therapy

• all pregnant women should be offered antiretroviral therapy regardless of whether they were taking it previously

Mode of delivery

• vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks, otherwise caesarian section is recommended
• a zidovudine infusion should be started four hours before beginning the caesarean section

Neonatal antiretroviral therapy