Patients without documented HIV infection should not be given antiretroviral therapy. Treatment, if used, must be aggressive to achieve maximal antiretroviral effects and suppression of viral replication. Therapeutic regimens for acute HIV infection should include the combination of two nucleoside inhibitors and one protease inhibitor. The drugs should be started simultaneously. Once therapy is initiated, many experts recommend continuing to treat indefinitely.
Research is ongoing to determine if there is a period after which therapy can be discontinued.
Risks to the fetus from effects of antiretroviral drugs are not well understood. Some clinicians might choose to delay therapy until after the first trimester of pregnancy, or, if the mother is already on an antiretroviral drug regimen, to stop all drugs until the second trimester. The zidovudine must be administered beginning as early as the 14th week of pregnancy and continued throughout pregnancy. The mother must receive intravenous zidovudine during labor and delivery, and the newborn must receive zidovudine during the first 6 weeks of life. Regardless of the independent indication for antiretroviral therapy in the mother, all HIV-infected women should receive this preventive therapy during pregnancy.