An audit of the management of HIV‐positive pregnant women and their babies: are we already meeting the 2012 BHIVA guidelines?

Purpose of the study In April 2012 the British HIV Association (BHIVA) issued revised guidelines for the management of HIV‐positive women in pregnancy and their babies following birth [1]. These reflect the increase in knowledge and developments in HIV care since 2008 when previous guidance was issued [2]. The purpose of this audit was to determine to what extent the management of the patients was consistent with this new guidance, and to identify areas where changes in practice may be required. Methods The audit included 100 HIV‐positive women and their babies, delivered between 2008 to 2012. The 2008 and 2012 BHIVA perinatal guidelines were reviewed and compared, key changes between the two were identified and auditable outcomes determined from these plus other crucial steps in their care. Data was collected retrospectively from a clinic database and where necessary, case‐notes, and compiled on to a spreadsheet, recording compliance with the auditable outcomes. Summary of results Compliance with the 2012 guidelines was demonstrated in most aspects of the maternal and neonatal care examined. Areas of less than optimal compliance include testing for hepatitis delta virus (HDV) in hepatitis B co‐infected women and performing resistance testing postnatally following antiretroviral therapy which is stopped postnatally. It was also found that in some cases antiretroviral therapy was switched in pregnancy, although this was most often due to reasons unrelated to the pregnancy such as toxicity or resistance, and where women were prescribed drunavir this was the once‐daily rather than the twice‐daily regime, although in all cases with good effect. Plans for appropriate mode of delivery were made for all women. In terms of neonatal antiretroviral prophylaxis, 99% received zidovudine monotherapy or triple therapy as appropriate depending on maternal viral load, and in 90% of cases this was started within 4 hours of birth in line with the 2012 guidelines. Conclusions The care provided to HIV‐positive women and their babies managed at our centre between 2008 to 2012 is largely of the standard set in the 2012 BHIVA guidelines. Areas for improvement identified by the audit include continuing HIV therapy without change during pregnancy, considering increasing the dose of darunavir, testing for HDV when appropriate, performing resistance tests when therapy is stopped post‐partum and increasing the proportion of neonates receiving prophylaxis within 4 hours of birth.