**5.3. What to do with HIV(+) pregnant women who reach 32 weeks of gestation without ART?**

In pregnant women reaching the 32nd week of gestation or more without ART, it is recom‐ mended to assess CD4 T-cell levels and VL and to initiate immediately ART with AZT/3TC coformulated, together with a protease inhibitor (PI). Nevirapine (NVP) can be used instead of a reinforced PI when CD4 T-cell counts are lower than 250 cells/mm3 (Grade D recommen‐ dation).

There is wide experience on the use of NVP during pregnancy. The drug has a risk of severe hepatotoxicity with CD4 >250 cells/mm3 , especially in coinfection with HBV and HCV. Several clinical guidelines propose such management based on expert recommendations. When NVP is used during delivery, AZT/3TC needs to be used subsequently to prevent drug resistance induced by NVP (Level 4 evidence) [15-21].

#### **5.4. What to do with HIV(+) pregnant women close to delivery date without prior ART?**

The following are to be observed:


Several clinical guidelines propose such management based on expert recommendations (Level 4 evidence) [15-21].

#### **5.5. What to do with HIV(+) pregnant women who have been treated with ribavirin?**

Because of the potential teratogenesis of ribavirin, its preconception withdrawal for at least 4 months in women and at least for 7 months in case the couple had received such drug should be counseled. In case of an eventual use during pregnancy, it should be immediately with‐ drawn, and a consultation visit should be arranged to assess maternal liver function.
