2. HISTORY
AIDS(Acquired Immunodeficiency Syndrome)
was first found in male homosexual in 1981 in
USA
In India,first HIV infection was reported in
1986 from prostitute in Chennai.
India has the largest HIV population in the world
compared to any single nation.
States with high prevalence of India include
Tamilnadu,Maharashtra,Karnataka,Andhra
Pradesh & Manipur.
3. MODES OF TRANSMISSION
Sexual contact with an infected partner.Most
common mode of transmission
Blood born- Infected blood & blood products
Parenteral Transmission- Sharing infected needles
Occupational exposure- By needle stick injury or
contamination with patient’s blood or body fluids.
Perinatal Transmission- From the infected
mother to the fetus or newborn.
4. HIV Screening during Pregnancy
Why:ART reducing the perinatal transmission
How :All the antenatal patients should undergo HIV testing
It cannot be made compulsary
It should not be done for any patient without prior counselling
and consent
5. Advantages of HIV screeing
Patient can choose the option of MTP.
Planned optimal care if continuation of pregnancy.
Implementation of strategies to reduce risk of fetal transmission.
Future planning can be done by couples.
6. Disadvantages of HIV screening
Psychological trauma- reduced by counselling.
Risk of social isolation.
Risk of marital disharmony.
7. Effects of HIV on pregnancy
Spontaneous abortion
Preterm labour and preterm babies
IUGR
Perinatal mortality
Incidence of perinatal transmission :15 to 35%
Transmission of HIV-2 is less frequent(1-4%) than
for HIV-1(14-35%)
8. Perinatal Transmission
Antepartum transmission :- across the placenta
10-50%
Intraparturm transmission :- during delivery as mentioned below
• direct contact with maternal blood &vaginal secretions while
passing through the birth canal.
•Ascending infection from the vagina or cervix to the fetal
membranes & amniotic fluid
•Absorption in fetal neonatal digestive tract,
•Maternal fetal microtranfusion during uterine coutractions in
labour,
40-80%
Postpartum transmission :- through breast feeding
10-20%
9. Risk factors of transmission
High viral load
Low CD4 count
Placental abruption
Vit. A deficiency
Invasive fetal monitoring
Vaginal delivary
Maternal P24 antigenemia
Other STDs presence
Preterm delivary
Advanced maternal age
Memberanes ruptured >4 hrs
Breast feeding
10. Management of HIV in pregnancy
Antepartum :• Most patients will be asymptomatic.
• Patient requires obsteric care + HIV care. Consult HIV specialist.
• MTP option is offered.
• Nutritional supplement including micronutrients.
• Routine antenatal investigation + Baseline CBC, LFT,RFT.
• Investigations of STDs, TB, Toxoplasmosis, Cytomegalovirus.
• CD4 count & vital load in each trimester. If CD4 count < 200, prophylactic
Antibiotics are indicated.
• Counsel against unprotected coitus.
• USG- Routine + Fetal well being assessment.
• Avoid invasive procedures.
11. Anti Retroviral Therapy(ART)
1.
ACTG 076 regimen:- (AIDS Clinical Trial Group)
Zidovudine(AZT)
Reduction of transmission:- 25.5% to 8.3%
2.
CDC Thai regimen :Zidovudine(AZT)
Reduction of transmission:- 50%
3.
HIV NET 012 regimen:-
Nevirapine
Reduction of transmission:- 47%
4.
PETRA study:-
Zidovudine(AZT) + Lamuvidine(3TC)
Reduction of transmission :- 69%
12. ACTG 076 regimen
Antepartum : oral AZT 100 mg 5times a day starting anytime from 1434 wks & continued till delivery.
Intrapartum : I/V AZT 2mg/kg. over 1 hour then 1 mg/kg/hour from
onset of labour until delivery.
Postpartum : To the neonate, 2mg/kg birth weight every 6 hours
for 6 weeks beginning 8-12 hours after birth.
13. CDC Thai regimen :
Antepartum : Oral AZT 300 mg twice daily starting at 36 wks gestation.
Intrapartum : Oral AZT 300 mg every 3 hourly from onset of labour till
delivery.
HIV NET 012 regimen :
NVP 200 mg tablet at the onset of labour.
NVP 2 mg/kg (single dose) to the newborn
within 72 hours of birth.
PETRA study :
Post exposure prophylaxis with triple therapy for 4 weeks.
AZT 200 mg tid + Lamivudin 150 mg bid + indinavir 800 mg
tid.
14. Universal work precautions
Wear double gloves, goggles, plastic apron, long gown, mask,
cap & overshoes (gum boots).
Protection from blood & amniotic fluid splash.
Minimal use of needles & sutures.
If needle stick injury occurs, remove the gloves, let the injury
site bleed, wash it throughly with soap & water & start
Zidovudine prophylaxis 1 to 2 hours of injury as per protocol.
Proper disinfevtion of gowns, gloves, masks, caps, goggles &
shoes. This is advised even if they are disposable. Immediate
immersing in bleaching powder solution is recommended.
Eventhrough delivery may be allowed in the same labour from
proper disinfection of floor, labour table & mattresses or rubber
used, is also done.
Proper disposal of blood, placenta, cord & deadbody (SB) by
incineration.
15. INTRAPARTUM MANAGEMENT
Elective LSCS reduces perinatal transmission upto 50-80%.
When labour has started or membranes have ruptured LSCS still
debated.
LSCS may increase the morbidity to immunocompromised mother.
During Delivery:• to take precaution for personal safety,to prevent spread,to
decrease perinatal transmission.
• Avoid ARM
• Avoid Vaginal tears
• Avoid Instrumental delivery
• Restrict Episiotomy
• Avoid fetal scalp electrode/ fetal blood sampling
16. POSTPARTUM MANAGEMENT
Wash newborn after birth,especially face.
Mouth suction is avoided,no mouth to mouth breathing
Avoid hypothermia
Anti Retroviral Therapy (ART)
All vaccines are given to asymptomatic children.While only
inactivated vaccines are recommended for symptomatic children
New born testing
ELISA TEST false positive upto 18 months
Before that to consider newborn positive 2
tests must be positive from
HIV 1 culture,p-24 antigen,PCR
17. BREASTFEEDING
Risk of transmission :-
10 to20%
Developing countries there is more risk of
neonatal death due to Infectious diarrhoea and
dehydration in bottlefed babies.
Also apart from it other advantages of BF to mother and child
So, WHO recommened that breastfeeding to be given
to the child born from mother who is HIV positive
