With regard to cervical cytology, HIV-positive pregnant women should be managed as per Guidelines C646 solubility dmso for the NHS Cervical Screening Programme 2010 [48]. Routine cytology should be deferred until after delivery, but if follow-up cytology or colposcopy is advised because of a previously abnormal result, then this should be undertaken. 4.2.1 Newly diagnosed HIV-positive

pregnant women do not require any additional baseline investigations compared with non-pregnant HIV-positive women other than those routinely performed in the general antenatal clinic. Grading: 1D 4.2.2 HIV resistance testing should be performed before initiation of treatment (as per BHIVA guidelines for the treatment of HIV-1 positive adults with antiretroviral therapy 2012; www.bhiva.org/PublishedandApproved.aspx ), except for late-presenting women. Post short-course treatment a further resistance test is recommended to ensure that mutations

are not missed with reversion during the off-treatment period. Grading: 1D In the case of late-presenting women, HAART, based on epidemiological assessment of resistance, should be initiated without delay and modified once the resistance test is available. 4.2.3 In 3-deazaneplanocin A datasheet women who either conceive on HAART or who do not require HAART for their own health there should be a minimum of one CD4 cell count at baseline and one at delivery. Grading: 2D 4.2.4 In women who commence HAART in pregnancy a VL should be performed 2–4 weeks after commencing HAART, at least once every trimester, at 36 weeks and at delivery. Grading: 1C Performing a VL test at 2 weeks allows for a more rapid assessment

of adherence and may be of particular benefit in a late-presenting woman. 4.2.5 In women commencing HAART in pregnancy, LFTs should be performed as per routine initiation of HAART and then at each antenatal visit. Grading: 1C Hepatotoxicity may occur because of the initiation of HAART and/or the development of obstetric complications such as obstetric cholestasis, pre-eclampsia, HELLP syndrome and acute fatty liver. Close liaison with the obstetric team is recommended. 4.2.6 In the Cell press event that a woman who has initiated HAART during pregnancy has not achieved a plasma VL of <50 copies/mL at 36 weeks the following interventions are recommended: Grading 1C Review adherence and concomitant medication. Perform resistance test if appropriate. Consider TDM. Optimize to best regimen. Consider intensification. For a woman who conceives on HAART that is not fully suppressive or loses virological control during pregnancy, these interventions should be undertaken as soon as possible. If treatment failure occurs when the infant is likely to be delivered prematurely and may be unable to take medication enterally, intensification should consist of therapies that readily cross the placenta such as double-dose tenofovir, raltegravir and single-dose nevirapine. 5.1.