Document review date February 2025.
NSD610-019.06 SPAIIN – Perinatal HIV Care Pathway – Late Presenter
Please download and complete the late presenter checklist electronically or print off and complete a paper version.
As a matter of urgency please contact a specialist centre (in NHS Lothian or NHS GG&C) for advice.
- See BHIVA 2018 (2020 third interim update) Pregnancy Guidelines – Section: 6.4 Late-presenting women not on treatment.
- A woman who presents after 28 weeks should commence ART without delay if not already on.
- If the HIV PCR is unknown or >100 000 HIV RNA copies/mL a three – or four – drug regimen that includes raltegravir 400mg BD or dolutegravir 50mg OD is suggested.
- An untreated woman presenting in labour at term should be given a stat dose of nevirapine 200mg and commence oral zidovudine 300mg with lamivudine 150mg BD and raltegravir 400mg BD.
- Intravenous zidovudine should be infused for the duration of the labour and delivery.
- In preterm labour (< 37+0 weeks), if the baby is unlikely to be able to absorb oral medications, consider the addition of a stat dose of tenofovir 490mg to the treatment in recommendations above to further load the baby.
- Women presenting in labour/with rupture of membranes (ROM)/requiring delivery without a documented HIV result must be recommended to have an urgent HIV test.
- A reactive/positive result must be acted upon immediately with initiation of the interventions for prevention of vertical transmission of HIV without waiting for further/formal serological confirmation.