Prevention of mother-to-child HIV transmission (PMTCT)

Sixteen percent of HIV in IRAN are women. It is important counseling and Managing Women Living with HIV, including preconception, antepartum, intrapartum, and postpartum. Preconception Counseling and Care for Women of Childbearing Age Living with HIV: Couples living with HIV infection should attain maximum viral suppression before attempting conception to prevent HIV sexual transmission and, for women living with HIV, to minimize the risk of HIV transmission to the infant. When the man is living with HIV, the use of donor sperm from a man who is HIV-uninfected is recommended. When the woman is living with HIV, assisted insemination at home or in a provider’s office with a partner’s semen during the peri-ovulatory period is recommended. Antepartum Care: Antiretroviral therapy (ART) ART including Tenofovir + Emtricitabine, Tenofovir + Lamivudine, Abacavir + lamivudine, Zidovudine + lamivudine should be recommended to all pregnant women living with HIV. Intrapartum Care: Women should continue taking their antepartum combination antiretroviral therapy (ART) on schedule as much as possible during labor and before scheduled cesarean delivery. Intravenous (IV) zidovudine should be administered to women living with HIV with HIV RNA > 1,000 copies/mL (or unknown HIV RNA) near delivery. It is not required for women receiving ART regimens who have HIV RNA ≤50 copies/mL during late pregnancy and near delivery and no concerns regarding adherence to the ART regimen. Infusion of IV zidovudine should begin 3 hours before scheduled cesarean delivery. 2mg/kg during first hour, then 1mg/kg should continue till delivery. Transmission and Mode of Delivery: Scheduled cesarean delivery at 38 weeks’ gestation to minimize perinatal transmission of HIV is recommended for women with HIV RNA levels > 1,000 copies/mL or unknown HIV levels near the time of delivery, irrespective of administration of antepartum ART. Scheduled cesarean delivery performed solely for prevention of perinatal transmission in women receiving ART with HIV RNA ≤ 1,000 copies/mL is not routinely recommended due to the low rate of perinatal transmission in this group. Postpartum Follow-Up: Breastfeeding is not recommended for women in the United States with confirmed or presumed HIV infection, because safe alternatives are available.