Pregnancy in women living with HIV: Experience of IRCCS San Gerardo dei Tintori and a narrative review

In this narrative review, inspired by the observation of changes in clinical practice implemented at our centre (IRCCS San Gerardo dei Tintori), we describe the evolution of care for pregnant women living with HIV (WLWH) and the current issues regarding ARV therapy, delivery, prophylaxis and breastfeeding. Over the years, advances in the care of HIV in pregnancy have significantly reduced the risk of perinatal transmission, making the experience of motherhood in WLWH comparable to that of people without HIV infection. However, some issues remain to be overcome to separate the real risks of transmission from the perceived fears and reduce the medicalization of pregnancy in WLWH. Notably, the rate of caesarean section remains higher than that of the general population, highlighting the need to further promote vaginal birth for WLWH in clinical practice and to reassure both women and physicians on its safety. Moreover, certain areas remain uncertain or subject to conflicting guidelines, such as the use of post-exposure prophylaxis for low-risk neonates and breastfeeding.