26; 95% CI 0.07–1.01). There was also a trend to lower HCV viral load in this group, which may go some way to explaining this. Also, in a small French cohort of co-infected women (29% on cART), rate of transmission see more did not differ significantly between children

born by vaginal delivery or CS [227]. cART should be given to all HCV/HIV co-infected pregnant women, regardless of CD4 cell count or HIV viral load because of the evidence of increased HIV transmission in co-infected mothers. 6.2.7 Where the CD4 cell count is < 500 cells/μL, cART should be continued if HCV viraemia exists because of the increased risk of progressive HCV-related liver disease. Grading: 1B 6.2.8 Where the pre-cART CD4 cell count was > 500 cells/μL and there is no HCV viraemia or fibrosis, cART 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 cART 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, continuing cART is recommended. Grading: 1C The decision to continue ARV or not postpartum depends on both HIV and HCV factors. There is consensus amongst guidelines that all persons with active (HCV-viraemic) co-infection should receive cART if their CD4 cell count is < 500 cells/μL [175, 176, 228]. In those women with CD4 cell counts of 350–500 cells/μL

Veliparib concentration who have cleared infection either spontaneously (around 25%) or after treatment and with a sustained virological response (SVR) and who have normal liver histology as judged by biopsy or hepatic elastometry, consideration should be given to continuing cART where the patient expresses a preference to do so. This is because until the completion of the randomized PROMISE trial, which addresses the question of whether to continue cART postnatally in mothers with CD4 cell counts > 400 cells/μL, there is equipoise as to correct management. In those with CD4 cell counts over 500 cells/μL, who received Lck cART to prevent MTCT, and who are not HCV-viraemic and have no evidence of established liver disease, ARVs can be discontinued. Without additional risk factors (such as alcohol, steatosis) and assuming they do not get re-infected, these women should have no further histological progression of their liver. In women with CD4 cell counts over 500 cells/μL who have established liver disease (inflammation or fibrosis), therapy should be continued. Interruption of ART in the SMART study was shown to lead to a greater risk of non-opportunistic disease-related death, particularly among those with HIV/HCV co-infection.