Thailand national guidelines for the prevention of mother-to-child transmission of HIV 2016

Abstract

© 2017, Asian Biomedicine. All rights reserved. Background: Thailand validated the elimination of mother-to-child transmission (MTCT) of HIV in June 2016 (meeting World Health Organization target < 2%). The Thailand National HIV Guidelines Working Group issued a new version of its national Prevention of MTCT guidelines in December 2016 aimed to reduce MTCT rate to less than 1% by 2020. Objectives: To organize national stakeholders for a new MTCT of HIV to further reduce MTCT of HIV Methods: The US CDC, Division of Global HIV/AIDS, medical scores, the Thai Red Cross AIDS Research Centers, and the Ministry of Public Health collaborated to develop Thailand National Guidelines for prevention of MTCT of HIV Results: The guidelines included recommending initiation antepartum highly active antiretroviral therapy (HAART) containing tenofovir disoproxil fumarate (TDF) plus lamivudine (3TC) plus efavirenz (EFV) regardless of CD4 cell count as soon as HIV is diagnosed for antiretroviral treatment (ART) naïve HIV-infected pregnant women. An alternative regimen is TDF or zidovudine (AZT) plus 3TC plus lopinavir/ritonavir (LPV/r) for the HIV-infected pregnant woman suspected to have NNRTI resistance. Treatment should be started immediately irrespective of gestational age and continue after delivery for life. Raltegravir is recommended in addition to HAART regimen for HIV-infected pregnant women who present late at ANC (gestational age (GA) ≥ 32 weeks) or those who have viral load (VL) > 1000 copies/mL at GA > 32 weeks. HIV-infected pregnant women who conceive while receiving HAART should continue this effective treatment regimen during pregnancy. HIV-infected pregnant women who present in labor and do not receiving HAART should receive single-dose nevira pine (SD-NVP) immediately along with oral AZT, initiate and continue HAART for life. Infants born to HIV-infected mothers are categorized into two groups (high risk vs. standard risk) based on their risk for MTCT. High MTCT risk is defined as an infant whose mother has VL > 50 copies/mL at GA > 36 weeks or has received HAART less than 12 weeks prior to delivery, or has poor ART adherence. These infants should be initiated AZT plus 3TC plus NVP for six weeks after delivery. Infants with standard MTCT risk should receive AZT syrup for 4 weeks. Exclusive formula feeding is recommended for all HIV-exposed infants. Conclusions: In addition to ARV therapy, other coordinated care are essential to further reduce MTCT of HIV in Thailand.