Treatment of HIV/AIDS in Pregnancy

This protocol covers antiretroviral therapy for individuals with HIV who are pregnant — a scenario where prompt treatment is essential for both maternal health and prevention of transmission to the infant.

Clinical scenario

Immediate initiation of ART is recommended for all pregnant individuals with HIV. Starting treatment without delay protects maternal health and substantially reduces the risk of perinatal and sexual transmission of HIV.

Treatment approach

The recommended regimen for this scenario uses a tenofovir-based nucleoside backbone combined with a boosted protease inhibitor — a combination selected specifically when certain other first-line options are not appropriate in pregnancy.

The complete regimen, dosing schedule, and full clinical decision pathway are available in the structured protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1001/jama.2024.24543

Immediate initiation of ART is recommended for all individuals with HIV who are pregnant for reasons of maternal health and to prevent perinatal and sexual transmission (evidence rating: AIa).

When dolutegravir is not an option or when HIV has been acquired after receiving long-acting cabotegravir for preexposure prophylaxis, TXF/XTC plus twice-daily darunavir (600 mg) plus ritonavir 100 mg is recommended (see Box 2) (evidence rating: AIa).

Darunavir (600 mg) plus ritonavir (100 mg), both given twice daily (evidence rating: AIa) with TAF/XTC or TDF/XTC; in people who have previously received long-acting cabotegravir for preexposure prophylaxis, this regimen is recommended over InSTI-based regimens.

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