Update to the Perinatal HIV Clinical Guideline

The Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission has updated the Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States guidelines sections to address new data and publications where relevant. Key updates are summarized below. All revisions are highlighted in yellow in the PDF (PDF, 5.68MB) version of the guidelines.

Pregnancy and Postpartum HIV Testing and Identification of Perinatal and Postnatal HIV Exposure

• When determining the timing of repeat HIV testing in the third trimester of pregnancy, some clinicians conduct testing at or around 28 weeks of gestation in conjunction with the recommended timing of syphilis testing.

Prepregnancy Counseling and Care

• The Panel has added a bulleted recommendation about the care for partners in the setting of childbearing potential with HIV.

Lack of Experience With Antiretroviral Drugs During Pregnancy and Prior to Pregnancy (Antiretroviral-Naive)

• Bictegravir (BIC) plus tenofovir alafenamide (TAF) plus emtricitabine (FTC) (available as the fixed-dose combination [FDC] BIC/TAF/FTC) is now recommended as a Preferred antiretroviral therapy (ART) regimen for HIV during pregnancy. BIC/TAF/FTC is also now recommended as a Preferred regimen when trying to conceive if ART and long-acting cabotegravir (CAB-LA) as pre-exposure prophylaxis (PrEP) have never been used previously.

Table 7. Situation-Specific Recommendations for Use of Antiretroviral Drugs During Pregnancy and When Trying to Conceive

• BIC, which is available in the FDC BIC/TAF/FTC, is now recommended as a Preferred antiretroviral (ARV) for use in pregnancy and when trying to conceive based on available data that suggest sufficient pharmacokinetics, efficacy, and safety in pregnancy.

Antiretroviral Drug Regimens and Pregnancy Outcomes

• The Panel recommends that ART should not be avoided or withheld before conception or in early pregnancy for the purpose of preventing preterm birth.

HIV-2 Infection and Pregnancy

• The Panel now recommends that ARV management of infants with potential in utero or intrapartum exposure to HIV-2 mono-infection or HIV-1/HIV-2 coinfection should follow recommendations for infants perinatally exposed to HIV-1 infection using drugs that are active against HIV-2.

Early (Acute and Recent) HIV Infection

• For instances of early (acute and recent) HIV infection and a history of CAB-LA use as PrEP, a regimen of ritonavir-boosted darunavir with (TAF or TDF) plus (FTC or 3TC) is recommended for initial ART.

Intrapartum HIV Care

• When HIV RNA is >1,000 copies/mL or is unknown near the time of birth, scheduled cesarean birth at 38 weeks of gestation is recommended to minimize the likelihood of perinatal HIV transmission.

Initial Postnatal Management of the Neonate Exposed to HIV

• The Panel has updated recommendations and content about infant safety monitoring.

Appendix B: Safety and Toxicity of Individual Antiretroviral Agents in Pregnancy

• The drug sections have been revised to include standardized language about the Antiretroviral Pregnancy Registry with a link to updated data provided through an interim reportExit Disclaimer released twice a year.

Clinicalinfo welcomes your feedback on the latest revisions to the Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States. Please send your comments with the subject line “Perinatal HIV Clinical Guidelines” to HIVinfo@NIH.gov by June 26, 2025.