4.2 If the VL is unknown or >100 000 HIV RNA copies/mL a three- or four-drug regimen that includes raltegravir is suggested. Grading: 2D 5.4.3 An untreated woman presenting buy GKT137831 in labour at term should be given a stat dose of nevirapine (Grading: 1B) and commence fixed-dose zidovudine with lamivudine (Grading: 1B) and raltegravir. Grading: 2D 5.4.4 It is suggested that intravenous zidovudine be infused for the duration of labour and delivery. Grading: 2C 5.4.5 In preterm labour, if the infant is unlikely to be able to absorb oral medications consider the addition of double-dose tenofovir (to the treatment described in 5.4.2) to further load the baby. Grading: 2C 5.4.6 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 Epigenetic animal study of the interventions for prevention of MTCT (PMTCT) without waiting for further/formal serological confirmation. Grading: 1D 5.5.1 Untreated women with a CD4 cell count ≥350 cells/μL and VL <50 HIV RNA copies/mL (confirmed on a separate assay):     Can be treated with zidovudine monotherapy or with HAART (including abacavir/lamivudine/zidovudine).

Grading: 1D   Can aim for a vaginal delivery. Grading: 1C   Should exclusively formula feed their infant. Grading: 1D 5.6.1 The discontinuation of non-nucleoside reverse transcriptase inhibitor (NNRTI)-based HAART postpartum should be according to BHIVA adult guidelines. Grading: 1C 5.6.2 ART should be continued in all pregnant women who TCL commenced HAART with a history of an AIDS-defining illness or with CD4 cell count <350 cells/μL as per adult treatment guidelines. Grading: 1B 5.6.3 ART should be continued in all women who commenced HAART for MTCT with a CD4 cell count of between 350 and 500 cells/μL during pregnancy that are coinfected with hepatitis B virus (HBV) or hepatitis C virus (HCV) in accordance with adult treatment guidelines. Grading: 1B 5.6.4 ART can be continued in all women who commenced HAART for MTCT with a CD4 cell count of between 350 and 500 cells/μL during pregnancy. Grading:

2C 5.6.5 ART should be discontinued in all women who commenced HAART for MTCT with a CD4 cell count of >500 cells/μL unless there is discordance with her partner or co-morbidity as outlined in Section 6. Grading: 2B 6.1.1 On diagnosis of new HBV infection, confirmation of viraemia with quantitative HBV DNA, as well as hepatitis A virus (HAV), HCV and hepatitis delta virus (HDV) screening and tests to assess hepatic inflammation and function are recommended. Grading: 1C 6.1.2 LFTs should be repeated at 2 weeks after commencing HAART to detect evidence of hepatotoxicity or immune reconstitution inflammatory syndrome (IRIS) and then monitored throughout pregnancy and postpartum. Grading: 1C 6.1.3 In the immediate period after discontinuing drugs with anti-HBV activity, LFTs and HBV DNA should be monitored frequently.