Grading: 1C 6.2.3 Coinfected mothers with HCV should not be treated for HCV with pegylated interferon with or without ribavirin and all women who discover they are pregnant while receiving treatment should discontinue both pegylated interferon and ribavirin immediately. Grading: 1B 6.2.4 In all non-immune HCV coinfected women after the first trimester, vaccination against HBV is recommended: Grading: 2C 6.2.5 HAV vaccine is recommended as per the normal

schedule (0 and 6-12 months), unless the CD4 cell count is <300 cells/μL when an additional dose may be indicated Grading: 2C 6.2.6 In the absence of obstetric complications, normal vaginal delivery can be recommended if the mother is receiving HAART. Grading: 2C Selleck VE 822 6.2.7 Where the CD4 cell count is <500 cells/μL, HAART should be continued if active HCV coinfection exists because of the increased risk of progressive HCV-related liver disease. Grading: 1B 6.2.8 Where the CD4 cell count is >500 cells/μL and there is no HCV viraemia or fibrosis, HAART should be discontinued. Grading:

2C 6.2.9 Where the CD4 cell count is >500 cells/μL and there is HCV viraemia and evidence of liver inflammation or fibrosis, continuing HAART is preferable because of a benefit on fibrosis progression. Grading: 2B 6.2.10 Where the CD4 cell count is between 350 and 500 cells/μL and there is no evidence of viraemia, inflammation or fibrosis, Selleck FK506 continuing Thymidylate synthase HAART is preferable if the patient displays a preference to do so. Grading: 2C 7.1.1 Fetal ultrasound imaging should be performed as per national guidelines regardless of maternal HIV status. Grading: 1D 7.1.2 The combined screening test for trisomy 21 is recommended as this has the best sensitivity and specificity and will minimize the number of women who may need invasive testing. Grading: 2C 7.1.3 Invasive prenatal diagnostic testing should not be performed until after the HIV status of the mother is known

and should be ideally deferred until HIV VL has been adequately suppressed. Grading: 1C 7.1.4 If not on treatment and the invasive diagnostic test procedure cannot be delayed until viral suppression is achieved, it is recommended that women should commence HAART to include raltegravir and be given a single dose of nevirapine 2–4 h before the procedure. Grading: 1D 7.1.5 External cephalic version (ECV) can be performed in women with HIV. Grading: 2D 7.2.1 Vaginal delivery is recommended for women on HAART with an HIV VL <50 HIV RNA copies/mL plasma at gestational week 36. Grading: 1C   For women taking HAART, a decision regarding recommended mode of delivery should be made after review of plasma VL results at 36 weeks.     For women with a plasma VL of <50 HIV RNA copies/mL at 36 weeks, and in the absence of obstetric contraindications, a planned vaginal delivery is recommended.