title: National Guidelines for the prevention of mother-to-child transmission of HIV across Europe - how do countries differ?
abstract: OBJECTIVE
  The aim was to summarize national prevention of mother-to-child transmission (PMTCT) guidelines across Europe and to identify differences between these.
  
  
  METHODS
  A survey was conducted using a structured questionnaire sent to experts in 25 European countries from January to March 2012, requesting a copy of the national guidelines. Responses were received from 23 countries.
  
  
  RESULTS
  Twenty-two (96%) countries supported a policy to recommend antenatal HIV screening for all pregnant women (15: opt-out strategy; 8: opt-in strategy). For HIV-positive women in whom the only indication for antiretroviral therapy (ART) was PMTCT, the recommended gestational age for commencing ART varied from 12 to 28 weeks: initiation before 19 weeks gestation was recommended in guidelines from nine countries; in France, the UK and the Netherlands, there was a wide range, from 14 to 24 weeks, whereas the Swiss and Ukrainian guidelines recommended starting at 24-28 weeks and the German/Austrian and Lithuanian at 28 weeks. Six national guidelines recommended inclusion of Zidovudine in antenatal ART regimens, and seven (37%) allowed continuation of Efavirenz for women conceiving on this drug. According to nine guidelines, zidovudine should always be used intrapartum. Eighteen national guidelines stated that HIV-positive women on successful ART can have a vaginal delivery. Viral load thresholds for vaginal delivery were <1000 copies/ml in 5 countries, <400 copies/ml in 3 and <50 copies/ml in 11 countries.
  
  
  CONCLUSIONS
  There are important differences across Europe in national PMTCT guidelines, with most variation seen where the evidence-base remains limited. Such differences should be considered when interpreting research and surveillance findings.
authors.affiliation: 1 St. James's Hospital, GUIDE Clinic, Dublin, Ireland.
authors.forename: Karoline
authors.initials: K
authors.lastname: Aebi-Popp
authors.forename: Fiona
authors.initials: F
authors.lastname: Mulcahy
authors.forename: Christoph
authors.initials: C
authors.lastname: Rudin
authors.forename: Irene
authors.initials: I
authors.lastname: Hoesli
authors.forename: Andrea
authors.initials: A
authors.lastname: Gingelmaier
authors.forename: Fiona
authors.initials: F
authors.lastname: Lyons
authors.forename: Claire
authors.initials: C
authors.lastname: Thorne
mesh_terms: D015492:AIDS Serodiagnosis / Q000592:standards; D000480:Alkynes; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use; D048588:Benzoxazines / Q000008:administration & dosage / Q000627:therapeutic use; D003521:Cyclopropanes; D003625:Data Collection; D036861:Delivery, Obstetric / Q000592:standards; D005060:Europe; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D011295:Prenatal Care / Q000379:methods / Q000592:standards; D011795:Surveys and Questionnaires; D015215:Zidovudine / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D015215:Zidovudine; C098320:efavirenz