All pregnant women should be screened for HIV infection when they book for antenatal care. HIV-positive women must have their CD4 count measured and be offered HIV prophylaxis before delivery. Usually AZT 300 mg orally twice daily is given from 28 weeks gestation followed by a 300 mg oral dose 3-hourly during labour. In addition, oral Nevirapine 200 mg should be given to the mother at the onset of labour. After delivery the infant should be given both:
- AZT syrup 12 mg (1.2 ml) twice daily for 7 days, or 4 mg/kg (0.4 ml/kg) if the birth weight is less than 2 kg
- Nevirapine syrup within 72 hours of delivery as a single dose of 6 mg (0.6 ml), or 2 mg/kg (0.2 ml/kg) if birth weight is less than 2 kg
HAART (Highly Active Antiretroviral Treatment) with 3 antiretroviral drugs should be given to HIV-infected pregnant women with a CD4 count below 200 cells/μL. This will reduce the risk of HIV transmission to the fetus if it is started before 28 weeks.
The gestational age when AZT is started is controversial and differs between services from 28 to 34 weeks. Soon 3TC may be added to the AZT courses to reduce the risk of drug resistance with mono or dual therapy.