HIV viral load

More frequent HIV viral load monitoring is recommended in pregnant women with HIV infection to ensure rapid and sustained virological suppression has been achieved. HIV viral load should be assessed at the initial visit, 2 – 4 weeks after initiating or changing ART, monthly until undetectable, and at least 3 monthly thereafter. If adherence is a concern, more frequent monitoring is required. HIV viral load should also be assessed at 34 – 36 weeks gestation to inform decisions about the mode of delivery and optimal treatment of the newborn.

If adherence is a concern, especially during early pregnancy, more frequent monitoring is recommended because of the increased risk of perinatal HIV transmission associated with detectable HIV viremia during pregnancy. Also, as pregnancy may reduce the drug exposure levels or the efficacy of some drugs, patients who are taking these drugs may require a change in therapy or more frequent viral load monitoring.

CD4+ T cell count

In women with HIV infection, a CD4+ T cell count should be performed at the initial visit and at least 3 monthly during pregnancy. The CD4+ T cell count will often go down slightly during pregnancy but will return to pre-pregnancy levels after delivery.

Monitoring of other laboratory tests during pregnancy

Pregnancy increases the risk of hyperglycaemia and women will usually have an oral glucose tolerance test performed during pregnancy, usually at 24 – 28 weeks of gestation. The majority of studies in women with HIV infection have not shown an increased risk of glucose intolerance and insulin resistance in those taking a PI-based regimen in pregnancy.^[42]