14
Diagnosis
V. SPECIAL CONSIDERATIONS FOR CISGENDER WOMEN
AND TRANSGENDER MEN OF CHILDBEARING
POTENTIAL AND FOR PREVENTION OF PERINATAL HIV
TRANSMISSION
Contraception and Preconception Care
81. All persons with HIV who are of childbearing potential should be
asked about their plans and desires regarding pregnancy upon
initiation of care and routinely thereafter. Clinicians should ensure
that informed decisions are made about contraception to prevent
unintended pregnancy, and offer counseling if pregnancy is desired.
Prevention of Perinatal Transmission
82. To prevent perinatal transmission, all pregnant persons with HIV
should be treated with ART, regardless of their immunologic or
virologic status. Therapy should be initiated as early as possible,
preferably prior to conception.
83. Infants exposed to HIV in utero should be managed according to
DHHS perinatal guidelines.
Breastfeeding
84. In the US, persons with HIV should avoid breastfeeding.
VI. SPECIAL CONSIDERATIONS FOR CHILDREN
85. Infants diagnosed with HIV should undergo HIV resistance testing
prior to administering ART and, because of the rapid progression of
disease, ART should be initiated as early as possible regardless of
CD4 cell count, HIV RNA level, or clinical status.
86. All children with HIV should initiate ART, regardless of CD4 count/
percentage, HIV RNA level, or symptoms.
87. CD4 cell counts and HIV RNA should be monitored no less than
every 3–4 months in infants and children.
88. Childhood vaccinations should be administered according to ACIP
schedules for infants and children with HIV.
89. Infants and children with HIV should be managed by a specialist
with knowledge of the unique therapeutic, pharmacologic,
behavioral, psychosocial, and developmental issues associated
with HIV.
