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World Health Organisation (WHO) PMTCT Guidelines
In 2013, the World Health Organisation (WHO) released new consolidated guidelines on the use of antiretroviral drugs (ARVs) for treating and preventing HIV infection.
The guidelines include recommendations for providing lifelong antiretroviral treatment (ART) to pregnant and breastfeeding women living with HIV for the prevention of mother-to-child transmission (PMTCT).
National PMTCT programme options
For pregnant and breastfeeding women living with HIV
WHO guidelines recommend that programmers follow Option B+, or Option B, if this is not possible.
- Option B+
Option B+ recommends providing lifelong ART to all pregnant and breastfeeding women living with HIV regardless of CD4 count or WHO clinical stage. Moreover, ART should be maintained after delivery and completion of breastfeeding for life.
- Option B
Option B recommends providing lifelong treatment only for pregnant and breastfeeding women eligible for ART.
For those eligible for treatment (i.e. with CD4 counts under 500 or at clinical stage 3 or 4), ART should be initiated and maintained after completion of breastfeeding. Those who fail to adhere to first-line ART during pregnancy or breastfeeding should be assessed for second-line ART. In the case of breastfeeding, ART should be stopped one week after the completion of breastfeeding. In the case of replacement feeding, ART should be stopped following delivery of the baby.
For those who are ineligible for treatment (with CD4 counts over 500), ART should be initiated but stopped after delivery and completion of breastfeeding. Again, patients who fail to adhere to first-line ART during pregnancy or breastfeeding should be assessed for second-line ART. In the case of breastfeeding, ART should be stopped one week after breastfeeding ends. In the case of replacement feeding, stop ART after delivery.
For HIV-exposed infants
All infants born to HIV-positive mothers should receive a course of medication linked to the ARV drug regimen that the mother is taking and the infants feeding method.
The infant should receive once-daily nevirapine (NVP) from birth for 6 weeks.
- Replacement feeding
The infant should receive once-daily NVP (or twice-daily zidovudine (AZT)) from birth for 4–6 weeks.
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