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| (1) History |
| (a) Comprehensive HIV history: when diagnosed; history of OIs or other HIV-related illnesses; ARV history (including use in prior |
| pregnancies); reason for change in ARV regimens (adverse effects, resistance, tolerability); adherence history/challenges; results of |
| resistance tests; nadir and current CD4 count; current HIV-RNA level |
| (b) Obstetric/Gynecological (OB/GYN) history |
| (i) Pregnancy history: number of previous pregnancies and their outcomes: miscarriages, abortions, ectopic pregnancy, |
| preterm births; number of living children and ages; number of HIV-infected children; pregnancy complications (preterm labor, |
| preeclampsia, birth defects, and so forth); mode of deliveries |
| (ii) GYN history: prior and current contraception use and satisfaction with method, adverse effects; current condom use; history |
| of sexually transmitted/genital tract infections; difficulty getting pregnant in past; abnormal pap smears and treatment; |
| other GYN problems and treatment (e.g., fibroids, endometriosis, etc.) |
| (c) General medical/surgical history: other medical conditions (e.g., diabetes, hypertension, renal or cardiac disease, depression or |
| other psychiatric illness, etc.); all prior surgeries; blood type and history of transfusions; allergies |
| (d) Immunization history: HBV, HAV, influenza, pneumococcus, HPV, tetanus |
| (e) Medications: complete list, including over-the-counter or complementary medications |
| (f) Nutrition assessment: vegetarian or other special diet, use of nutritional supplements/vitamins, history of anemia or nutritional |
| deficiencies |
| (g) Social history: relationship status; use of illicit drugs/tobacco/alcohol; employment status; social support and disclosure to |
| partner/others; economic support; history of domestic violence and nature of violence (physical, sexual, psychological) |
| (h) Family history of heritable diseases: birth defects, chromosomal abnormalities, muscular dystrophy, sickle cell disease, |
| mental retardation, etc. |
| (i) Relevant male partner history: HIV status and knowledge of partner’s status; if HIV-infected: disclosure history; history of OIs, |
| other HIV-related conditions; ART history and history of adverse effects, resistance, adherence problems; nadir/current CD4 count; |
| current HIV-RNA level; medical/reproductive history; medications; use of illicit drugs, tobacco, alcohol; employment |
| (2) Examination: comprehensive, with focus on genital tract |
| (3) Laboratory: emphasis on labs that will affect counseling and/or result in changes in care prior to pregnancy |
| (a) STI screening (gonorrhea/chlamydia; syphilis; HSV culture or HSV-2 antibody (if indicated by exam or history in patient |
| or partner) |
| (b) CBC |
| (c) Current CD4/HIV-RNA, resistance testing (if indicated) |
| (d) Rubella |
| (e) Hepatitis: HBV: HBsAb (if no history of HBV vaccination), HBsAg; HCV antibody, HCV-RNA, if indicated |
| (f) Pap |
| (g) Other as indicated by medical history, medications |
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