Related to Pregnancy

1. HIV / AIDS DURING
PREGNANCY
PRESENTED BY:
LAMNUNNEM HAOKIP
MSC (N) 2ND YEAR
SNSR, SU
UNDER THE SUPERVISION
OF
DR. SHANTI IDA
PROF.CUM HOD (OBG)
SNSR, SU

2. INTRODUCTION
• Human Immunodeficiency Virus (HIV)
causes an incurable infection that leads
ultimately to a terminal disease called
Acquired Immunodeficiency Syndrome
(AIDS).
• Worldwide 25 – 30% of infected patients
are women and 90% of them are 20 – 49
years of age.

3. DEFINITION
• Human Immunodeficiency Virus (HIV) : It
belongs to retrovirus family which is the
causative agent of Acquired
Immunodeficiency Syndrome (AIDS).
• Acquired Immunodeficiency Syndrome
(AIDS): A disease in which there is a severe
loss of the body's cellular immunity, greatly
lowering the resistance to infection and
malignancy.

4. IMMUNOPATHOGENESIS
• The target for HIV is the CD4 receptor molecule.
• Cells within the immune system that have this
molecule are : CD4+ T lymphocytes, monocytes,
macrophages and other antigen presenting cells
like fibroblasts, neurons, renal, hepatic and
intestinal cells.
• Following infection, there is profound cellular
immunodeficiency as the CD4+ are progressively
depleted by cytopathic effects of HIV.

5. Immunological markers that are used to
determine the progression of the disease are as
follows:
• CD4 T lymphocytes count – patients with count
from 200 – 300 cells/mm3 are likely to have HIV
related symptoms and count <200 cells/mm3 is
taken into AIDS defining criteria.
• Measurement of HIV RNA levels by RT-PCR and
the bDNA assays.

6. MODE OF TRANSMISSION
• Multiple partners, prostitution.
• IV drug abusers
• Multiple transfusion of blood and blood
products
• Parent to child

7. CLINICAL PRESENTATION
Acute infection syndrome is characterized
by:
• Fever
• Skin rash
• Arthralgia
• Lymphadenopathy
• Diarrhoea - This is called seroconversion
illness. It lasts less than 2-3 weeks and
resolves spontaneously.

8. AIDS related complex refers to subjects
having nonspecific clinical features like:
• Weight loss
• Fever, diarrhoea, herpes simplex, oral or
recurrent genital candidiasis, oral or genital
ulcers.
• Pelvic Inflammatory Disease
• Tubo-ovarian abscess.
• Thrombocytopenia.

9. PARENT TO CHILD TRANSMISSION
• Vertical transmission to the neonates is
about 14 – 25%.
• Trans-placental transmission occurs 20%
before 36 weeks and over 80% of
transmission around the time of labour
and delivery.
• Vertical transmission is more in cases
with pre-term birth and with prolonged
membrane rupture.

10. • Risks of vertical transmission are directly
related to maternal viral load and
inversely to maternal immune status.
• Maternal Antiretroviral Therapy reduces
the risk of vertical transmission by 70%.
• The maximum risk of transmission form
parent to child is the peri-partum period
and intra-partum period.

11. PREVENTION OF PARENT TO CHILD
TRANSMISSION :
Guidelines by National AIDS Control
Organization (NACO):
• HIV testing is recommended in all pregnant
women which is opt-out approach.
• Antiretroviral therapy is recommended for all
HIV positive women irrespective of their CD4
counts.
• Vaginal delivery is recommended, Caesarean
section is not the only option.

12. INTERVENTION RISK OF HIV
TRANSMISSION
FROM MOTHER
TO CHILD
No intervention and
continue breastfeeding
30 – 45%
No ART and stop
breastfeeding
20 – 25%
ART and continue
breastfeeding
2%
ART and no
breastfeeding
1%

13. PROPHYLAXIS ON
ANTIRETROVIRAL THERAPY(ART)
• Initiate antiretroviral therapy in pregnancy as
soon as diagnosed with HIV positive. Once
started, it should be life-long.
Starting ART for the first time: Triple drug
regime:
• Tenofovir – 300 mg
• Lamivudine – 300 mg
• Efavirenz – 600 mg (considered safe in
pregnancy in all the trimester by world health
organization).

16. Women already on Antiretroviral Therapy
• If the mother is already on ART, she should
continue the regime.
Recommendations for delivery
• Vaginal delivery
• Caesarean section for obstetric indications.
• Minimize the vaginal examination
• Avoid early rupture of membrane.
• Avoid prolonged labour (Oxytocin can be used).
.

17. • Avoid routine episiotomy.
• Avoid unnecessary instrumentation
• During post-partum, methergine is
avoided because ART drugs and
methergine potentiates increase risk of
hypertension.
• According to world health organization,
there is no rush in early cord clamping.

18. Recommendations for Infant Prophylaxis
• After birth the infant should also get ART
prophylaxis irrespective of the mode of feeding
of the infant (breastfed and replacement fed
babies).
• Mother who has taken ART more than 4 weeks
during pregnancy, the infant should be given
Syrup Nevirapine for 6 weeks after delivery /
birth.

20. • Mother has taken ART less than 4 weeks
during pregnancy, the infant should be
given Syrup Nevirapine for at least 12
weeks.
• For a mother who took Nevirapine in the
past or previous pregnancy, for the infant
Syrup Zidovudine.

21. STANDARD SAFETY MEASURES
Prenatal Care:
• Screening should be offered voluntarily.
• Counselling about the risks of HIV
transmission from parent to child.
• Tuberculin test should be test to find out
any associated factors which can leads to
HIV/AIDS.

22. Intra-partum Period
• Avoid instrumentations during labour.
• Careful handling of fluids of the mother.
• Use of personal protective equipment.
Post-partum Period
• Counsel regarding the breastfeeding and
help to informed choice.
• Keeping the perineal area clean with
antiseptic solutions to prevent infections

23. The followings are the safety measures to prevent form
transmission of HIV/AIDS from one person to another:
• HIV testing and linkage to care, HIV medications and
Access to condoms
• Prevention programs for people with HIV and their
partners
• Prevention programs for people at high risk for HIV
infection
• Substance abuse treatment and access to sterile syringes
• Sexually Transmitted Infections screening and treatment.
• Use of personal protective equipments.

24. SUMMARY
&
CONCLUSION

25. BIBLIOGRAPHY / REFERENCE
• DC Dutta’s. Hiralal Konar. Textbook of
Obstetrics. 8th Edition. Jaypee The Health
Sciences Publishers. Page no. 350 – 353.
• Anamma Jacob. A cComprehensive
Textbook of Midwifery and Gynaecological
Nursing. Fourth Edition. Jaypee The Health
Sciences Publishers. Page no. 321 – 323.
• DC Dutta’s Hiralal Konar. Textbook of
Gynaecology. 7th Edition. Jaypee the health
sciences publishers. Page no.126 – 128.
• Park K. Park’s Textbook of Preventive and
Social Medicine, twenty fifth edition.
Banarsidas Bhanot Publishers; page no.
310 – 8.
• https://youtu.be/xIOqLQGQthQ

26. • https://www.acog.org/womens-
health/faqs/hiv-and-
pregnancy#:~:text=During%20pregnancy%2
C%20HIV%20can%20pass,breaks%20(her%
20water%20breaks).
• Royal College of Obstetricians and
Gynaecologists, Royal College of Midwives,
Royal College of Anaesthetists, Royal
College of Paediatrics and Child Health.
Standards for Maternity Care. Report of a
Working Party. London: RCOG Press; 2008
[http://www.rcog.org.uk/ womens-
health/clinical-guidance/standards-maternity-
care].