Clinical scenario	Management recommendations
Antiretroviral therapy
Scenario 1: HIV-infected pregnant woman not previously exposed to antiretroviral drugs	Antiretroviral drug therapy is selected based on the same parameters used in nonpregnant HIV-infected women. The regimen should include orally administered zidovudine (Retrovir) during pregnancy and intravenously administered zidovudine during labor.
Scenario 2: HIV-infected woman receiving antiretroviral drugs during current pregnancy	Continuation of antiretroviral drug therapy should be considered. Zidovudine should be incorporated into the regimen and should be given intravenously during labor.
Scenario 3: HIV-infected woman in labor with no previous antiretroviral drug therapy	Consider one of four regimens: 1. Single dose of orally administered nevirapine (Viramune) given to the mother at the onset of labor, and single dose given to the newborn by 48 hours after birth 2. Orally administered lamivudine-zidovudine (Combivir) given to the mother during labor and to the newborn for 1 week after birth 3. Intravenously administered zidovudine given to the mother during labor, and orally administered zidovudine given to the newborn for 6 weeks after birth 4. Two doses of orally administered nevirapine and intravenously administered zidovudine given to the mother during labor, and orally administered zidovudine given to the newborn for 6 weeks after birth
Scenario 4: Infant of an HIV-infected mother who did not receive antiretroviral drugs during pregnancy or labor	Give orally administered zidovudine to the newborn for 6 weeks after birth. Consider use of additional antiretroviral drugs.
Mode of delivery
Scenario A: HIV-infected woman presenting late in pregnancy, not receiving antiretroviral drug therapy and unlikely to have laboratory evaluations before delivery	Begin antiretroviral drug therapy. Consider elective cesarean section at 38 weeks of gestation.
Scenario B: HIV-infected woman initiating prenatal care in third trimester, receiving highly active antiretroviral drug therapy but with a viral load of >1,000 copies per mL	Continue antiretroviral drug therapy as long as the viral load is dropping appropriately. Consider elective cesarean section at 38 weeks of gestation.
Scenario C: HIV-infected woman on highly active antiretroviral drug therapy with an undetectable viral load	Whether elective cesarean section has any additional benefit is unclear. The risk of vertical transmission of HIV is less than 2 percent with vaginal delivery.
Scenario D: HIV-infected woman who has elected cesarean section for delivery but presents in labor	Begin intravenous administration of zidovudine. If delivery is imminent, vaginal delivery may be used, with oxytocin (Pitocin) augmentation considered. If a long labor is anticipated, consider proceeding with cesarean section. The risk of vertical transmission of HIV is increased with rupture of membranes for longer than 4 hours.