- The British HIV Association (BHIVA) has updated its guidelines on management of HIV in pregnancy and expanded them to include the postpartum period.
- It has also issued new guidelines on the use of pre-exposure prophylaxis (PrEP).
The pregnancy/postpartum guidelines contain several changes to the content or strength of previous recommendations. More detail has been added on breastfeeding and other areas of controversy, the BHIVA says, and the section on psychosocial care has been expanded. There is also a new section on postpartum management.
The BHIVA continues to recommend that women living with HIV in the UK feed their babies with formula milk. This is stated to be the safest option in high-income countries, as there is no on-going risk of HIV exposure after birth. Women who are virologically suppressed on combination antiretroviral therapy (ART) with good adherence and who choose to breastfeed should be supported to do so, the guideline says. However, they should be informed about the low risk of transmission in this situation, and extra clinical monitoring of mother and baby are required.
The document includes guidance on the use of ART both to prevent vertical transmission and for the welfare of the woman and her baby, the mode of delivery, and management of special patient populations.
The PrEP guideline, issued jointly by the BHIVA and the British Association for Sexual Health and HIV (BASHH), covers risk assessment prior to PrEP, baseline assessment, dosing schedules, monitoring, supporting adherence, buying generic PrEP, and cost-effectiveness. The guidelines recommend that PrEP with on-demand or daily oral tenofovir-emtricitabine (TD-FTC) should be offered to several defined groups. Due to lack of supporting evidence, it is suggested that tenofovir alone should not currently be offered as PrEP to men who have sex with men.
The guidelines can be viewed on Univadis, and are also freely available to download from the BHIVA website.