Unit 5 drug regimens for pmtctPresentation Transcript
Drug regimes for PMTCT and their use during pregnancy, intrapartum and postpartum
Session Objective and content
Objective: At the end of the session the participant should be able Describe the various drug regimes for PMTCT used during pregnancy, intrapartum and postpartum including short course ART
Use of antiretroviral drugs and pregnancy
Selection of short course ART regimens for PMTCT-- efficacy, toxicity, timing of initiation and cessation
Use of HAART for PMTCT
Antiretrovirals in PMTCT
Long-term use of antiretroviral drugs to manage maternal HIV/AIDS and prevent PMTCT.
Short-term use of antiretroviral drugs to reduce HIV transmission from mother to infant.
Prophylaxis with nevirapine
Prophylaxis with AZT and nevirapine
Post exposure prophylaxis
Prophylaxis with HAART
Antiretrovirals and pregnancy
Nucleoside analogue drugs are known to induce mitochondrial dysfunction,
highest for zalcitabine (ddC), didanosine (ddI), stavudine (d4T).
Present as neuropathy, myopathy, cardiomyopathy, pancreatitis,
Efavirenz: birth defects with first trimester exposure (polydactaly, hydronephrosis; bilateral hip dislocation, umbilical hernia, urinary obstruction and neural tube defects)
Hyperglycemia, and diabetic ketoacidosis reported with protease inhibitor.
increased risk of preterm delivery for infants exposed to combination therapy with or without protease particularly started before pregnancy
CP450 inhibition by Protease inhibitors can lead to ergortism with administration of ergometrine
Interaction of Nevirapine for PMCT and for ART
NNRTI based HAART, often with NVP, is the first line treatment regimen in resource limited settings based on WHO recommendations
Based on cost, efficacy, full awareness of toxicities
NVP alone or in combination with other ARVs is the most commonly used drug for PMTCT in developing countries
safety concerns higher risk of liver and cutaneous adverse events among women with>250 CD4 count with chronic (non single dose) NVP
Resistance even with single dose
Prophylaxis with Nevirapine (NVP)
A single 200 mg tablet for the mother to take at the onset of labour
A single dose of oral suspension (standard dosage = 2 mg/kg) to be given to the infant immediately after birth or within 72 hours of delivery.
Prophylaxis with AZT and NVP
Mother: AZT 300 mg twice daily starting at 28 weeks or as soon thereafter as possible. AZT may be started as late as 36 weeks.
Mother: AZT 300 mg at onset of labour and every 3 hours until delivery and single-dose NVP 200 mg at onset of labour.
AZT 600 mg at onset of labour AND single-dose NVP 200 mg at onset of labour.
Infant: NVP 2 mg/kg oral suspension immediately after birth or within 72 hours of delivery and AZT 4 mg/kg twice a day for 7 days.
NVP 2 mg/kg oral suspension immediately after birth or within 72 hours of delivery.
Post exposure prophylaxis 13.4% Vs 17% difference NS 16.2% NVP stat Vs AZT 6 weeks South Africa (secure future) 22% 39% difference 14% NVP stat vs NVP stat + 7 day AZT Malawi Forgarty TX and efficacy Infant Regimen
HAART for PMTCT
Avoid EFV unless in late pregnancy
Defer in 1 st trimester
Monitor as with HAART treatment
Most experience with
The implementation of strategies to provide
Treatment, care and support of women
infected with HIV, their infants and their
Monitoring the growth and development of the HIV-exposed child including immunisations
Prevention and treatment of opportunistic infections
Diagnosis of HIV
Mother and partner
Support for implementation of safer infant-feeding practices
Counselling in family planning
Assessment and initiation of ARV therapy
Linkage to related community service organisations and agencies to promote continuity of care