Many HIV-positive women will have issues relating to social support needs and/or immigration issues. In both cases, it is important to identify the issues as early as possible so that women can be referred for appropriate specialist advice and support. Women with very limited funds should have access to supplementary formula feed [314, 349]. Dispersal is an issue that arises

and is generally felt to be inappropriate in pregnant women, especially if they are late in pregnancy or are recently delivered [350-352]. The testing of existing children should be raised with all newly diagnosed pregnant women. In practice, if the children are asymptomatic the testing is often most easily done when the newborn is attending paediatric follow-up for HIV diagnostic tests [353]. Adherence to medication is of vital importance for the success of therapy, and pregnant women may need extra support and Opaganib manufacturer planning in this area, especially if there are practical or psychosocial issues that may impact adversely on adherence. Referral to peer-support workers, psychology support and telephone contact may all be considered [354]. Legislation concerning eligibility to free NHS healthcare in the UK changed in 2004. Patients who

have been resident in the UK for 12 months do not have an automatic entitlement to free care in the NHS. There is an exclusion for ‘immediately necessary care’ Proteasomal inhibitor and it has been argued that treatment of an HIV-positive pregnant woman falls within this category. Since 1 October 2012, HIV patients have

not had to meet any residency requirement in order to access treatment. It is freely available regardless of immigration status. Unfortunately this may still be interpreted differently within different Trusts, in some cases putting the health of mothers and their unborn babies at risk. No hospital PLEKHM2 should refuse treatment for HIV-positive pregnant women to prevent transmission of HIV to the baby. However, it is possible that women who are otherwise ineligible for free NHS care may be liable for charges subsequently. It is advisable to get advice from colleagues, the GMC, BMA and Medical Defence Organizations in difficult cases. Legal advice can also be sought from organizations such as the Terrence Higgins Trust (THT) (www.tht.org.uk), or the National AIDS Trust (www.nat.org.uk). Postnatal depression is relatively common in the general population, tends to be underdiagnosed and is a risk in HIV-positive women. Women with, or at risk of, antenatal depression should be assessed early and referred onward appropriately [355]. The Writing Group thanks Dr David Hawkins, Dr Fiona Lyons and Dr Danielle Mercey for their peer-review of the Guidelines. Dr A de Ruiter has received lecture and consultancy fees from Bristol-Myers Squibb, Gilead and ViiV. Dr GP Taylor has received lecture and consultancy fees from AbbVie and his department has received research grants from Abbott. Dr A Palfreeman has received conference support from Gilead.