Table 5. HIV-Related Laboratory Monitoring Schedule for Pregnant People With HIV

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Table 5. HIV-Related Laboratory Monitoring Schedule for Pregnant People With HIVa
Laboratory Test Timepoint or Frequency of Testing
Entry Into Antenatal Carec ART Initiation or Modification 2 to 4 Weeks After ART Initiation or Modification Monthly Every 3 Months During Pregnancy At 24 to 28 Weeks Gestation At approximately 36 weeks of Gestation or within 4 weeks of delivery to Inform Mode of Delivery and Infant ARV Regimen
HIV RNA Levelsb

√c

√

If a result is not available within 2weeks of ART initiation or modification

√

√

Until HIV RNA levels are undetectable

√

At least every 3monthsd

  

√
CD4 Counte

√ c

      

√

For patients who have been on ART for <2 years, patients with CD4 counts <300cells/mm3, and patients with inconsistent adherence and/or detectable viral loads

    
Resistance Testingf  

√

          
HLA-B* 5701 testing  

√

If abacavir use anticipated

          
Standard Glucose Screeningg          

√

 

  
Complete Blood Cell Count; Renal Function

√

√

With additional testing as clinically indicated

      

√

  

Liver Function

√

√

    

√

With additional testing as clinically indicated

    
Monitoring for ARV-Specific Toxicitiesh

Refer to the recommendations in the package inserts for the individual ARV drugs.
a For additional information see Laboratory Monitoring in the Adult and Adolescent Antiretroviral Guidelines.

b The plasma HIV RNA levels of pregnant people with HIV should be monitored at the initial antenatal visit with a review of prior HIV RNA levels (AI), 2 to 4 weeks after initiating (or changing) antiretroviral therapy (ART) (BI), monthly until RNA levels are undetectable (BIII), and then at least every 3 months during pregnancy (BIII). Obtain an HIV RNA level at the time of ART initiation or modification if a recent result within 2 weeks prior is not available.

c Prior HIV-related illnesses and past plasma HIV RNA levels and CD4 cell counts should be reviewed at entry into antenatal care.

d More frequent viral load monitoring (every 1–2 months) may be indicated for patients who are taking ARVs that have been shown to have reduced drug levels in the second and third trimesters (e.g., cobicistat, elvitegravir, rilpivirine) and are potentially at risk for loss of viral suppression (see Table 6 and Table 7 and Pregnant People With HIV Who Are Currently Receiving Antiretroviral Therapy).

e CD4 count should be measured at the initial antenatal visit (AI). Patients who have been on ART for ≥2 years and who have had consistent viral suppression and CD4 counts that are consistently >300 cells/mm3 do not need to have their CD4 counts monitored after the initial antenatal visit during this pregnancy, per the Adult and Adolescent Antiretroviral Guidelines (CIII). Patients who have been on ART for <2 years, patients with CD4 counts <300 cells/mm3, and patients with inconsistent adherence and/or detectable viral loads should have CD4 counts monitored every 3 months during pregnancy (CIII).

f ARV drug-resistance testing (genotypic testing and, if indicated, phenotypic testing) should be performed in patients whose HIV RNA levels are above the threshold for standard resistance testing (usually >500 copies/mL to 1,000 copies/mL but may be possible for HIV RNA >200 to ≤500 copies in some laboratories). Testing should be performed before—
 
  • Initiating ART in ARV-naive pregnant patients who have not been tested previously for ARV drug resistance (AII);
  • Initiating ART in ARV-experienced pregnant patients (AIII); or
  • Modifying ARV regimens for patients who become pregnant while receiving ARV drugs or patients who have suboptimal virologic response to ARV drugs that were started during pregnancy (AII).
ART should be initiated in pregnant patients prior to receiving the results of ARV-resistance tests. ART should be modified, if necessary, based on the results of resistance testing (BIII).

g Patients who are taking ART during pregnancy should undergo standard glucose screening (AIII). Some experts suggest performing glucose screening early in pregnancy for patients who are receiving PI-based regimens that were initiated before pregnancy, in accordance with recommendations for patients who are at risk for glucose intolerance (BIII). For more information on PIs, see Combination Antiretroviral Drug Regimens and Maternal and Neonatal Outcomes.

h Laboratory testing to monitor complications of ARV drugs during pregnancy should be based on what is known about the adverse effects of the drugs a woman is receiving (AIII).

Key: ART = antiretroviral therapy; ARV = antiretroviral; CD4 = CD4 T lymphocyte; LFT = liver function test; PI = protease inhibitor

 

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