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HIV and pregnancy: how to manage conflicting recommendations from evidence-based guidelines

Giles, Michelle L.a,b

doi: 10.1097/QAD.0b013e32835ce308

In resource rich settings transmission of HIV from mother to child during pregnancy and post partum has been significantly reduced by access to interventions such as maternal and neonatal antiretroviral therapy, avoidance of breast feeding and consideration to caesarean section. Accumulating observational and randomised controlled studies provide the evidence for development of guidelines for the clinical management of these women. However, despite referencing the same studies, differences exist between recommendations originating from the United States versus the United Kingdom. The particular areas of controversy include use of efavirenz, dose adjustment of antiretrovirals during pregnancy, mode of delivery according to maternal viral load, duration of neonatal zidovudine, use of PJP prophylaxis and number of antiretrovirals to prescribe in a neonate considered high risk of acquiring HIV infection. This article summarises these differences and suggests ways of approaching and adapting these conflicting recommendations to the local setting.

aInfectious Diseases Unit, Alfred Hospital

bDepartment of Infectious Disease, Monash University, Melbourne, Australia.

Correspondence to Michelle L. Giles, Infectious Diseases Unit, Alfred Hospital, P.O. Box 315, Prahran, Victoria, Australia 3181. E-mail:;

Received 16 September, 2012

Revised 6 November, 2012

Accepted 21 November, 2012

© 2013 Lippincott Williams & Wilkins, Inc.