**5.2. What to do with HIV(+) women undergoing ART who become pregnant?**

Women undergoing ART who become pregnant are recommended to maintain ART if their VL is undetectable. If the regimen includes drugs that increase toxicity (D4T) or contains Efavirenz, these should be withdrawn and replaced with lopinavir/ritonavir or by saquinavir/ ritonavir, including, when possible, AZT in the regimen (Grade D recommendation). The WHO guidelines do not recommend the use of the antiretroviral medication efavirenz (EFV) during the first trimester of pregnancy because of its potential fetal teratogenic effects, mostly involving defects of neural tube closure. Nevertheless, there are no categorical studies supporting such recommendation (Level 3 evidence). Likewise, the use of the ddl/d4T combination should be terminated [15-21].

The genotyping study should be performed on pregnant women undergoing ART with VL >1,000 copies/ml, particularly in pregnancies that have not achieved such goal at 34 weeks of gestation. Moreover, the addition of a single dose of nevirapine at the moment of delivery is suggested (Grade D recommendation).

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