PPT pesentation about HIV in pregnancy.

1. HIV IN PREGNANCY
DR.Paramanantham

2. • According to NACO (National AIDS Control
Organisation) 2012, 27 million pregnancies
occur annually in India of which 37% are HIV
positive. 13,000 babies born to HIV positive
are infected.
• PPTCT(2002)- Prevention of Parent to Child
Transmission
• 15,000 HIV testing centres are there in India
• India has the 2nd largest population of HIV
positive

3. Natural history of HIV:
Accussition
Primary infection
Asymptomatic
Later symptomatic
Advanced
Types of HIV
• HIV 1
• HIV 2

4. Pathology:
• Attachment of virus to host cell
• Progressive loss of immune function
• T lymphocytes
• Unique reproduction cycle
After infection the viral load decreases

5. HIGH RISK FACTORS:
• Injection drug use
• Prostitution
• Multiple sexual partners
DIAGNOSIS:
• Initial screening by ELISA against core p24 ,
confirmed by western blot or IFA
• Clinical progression is monitored by evaluating
CD4 cell counts

6. Clinical features:
• Fever
• Night sweats
• Fatigue
• Headache
• Myalgia
• Lymphadenitis
• Vomiting
• Diarrhoea

7. AIDS is developed after 10 yrs
Oral hairy leucoplakia
Apthous ulcers
Thrombocytopenia
14% of HIV passes through breast milk
Can mixed feeding be given?
No it is dangerous as it increases faster spread
of viremia.

8. In twin pregnancy the 1st twin is affected more
Perinatal transmission
30% by 36 weeks
50% before discharge
30% intrapartum
5 ‘C’s – Informed consent, Confidentiality,
Counselling, Correct test

9. Systemic involvement in HIV:
• Kidney – nephrotic syndrome, if not
responding to steroids may respond to
cyclosporin
Symptoms- polyuria, oliguria and hematuria
• CVS – Left ventricular hypertrophy, monitor
for cholestrol,lipids and altered lifestyle
• GI- cryptosporidium, microsporidium leading
to chronic diarrhoea, malabsorption and
pancreatitis
• Skin – seboric dermatitis,eczema, chickenpox,
epidermic hyperkeratosis

10. • Blood- anemia, leucopenia,
thrombocytopenia, kaposis sarcoma
• Rs- recurrent URTI, Tb, TORCH infection and
LIP(lymphocytic inflammatory pneumonia)
• CNS- Encephalopathy, CNS lymphoma,CNS
toxoplasmosis
• Viral infections- measles and immunity
recurrent inflammatory syndrome
• Parasitic infection- microsporidium chronic
diarrhoea

11. INITIAL ASSESSMENT:
• Routine investigations plus base line renal and
liver function tests
• Plasma HIV RNA quantification- viral load ,
CD4+ T lymphocyte count and antiretroviral
resistance testing
• HSV 1 and 2, TORCH panel screening for other
STI
• Testing for hepatitis A,C,E
• Baseline chest radiograph and mantoux
• Ultrasound for fetal well being

12. 1) Prenatal HIV counselling should be offered to
all pregnant women
2) Hiv infected women are prone to infections
like tuberculosis, pneumonia, thrush and
other opportunistic infections
3) Strategies to prevent vertical transmission:
Decrease fetal viral exposure by preventing
chorioamniocentesis, shortening the
duration of labour , delay rupture of
membranes and preventing vaginitis

13. The AIDS clinical trial group – 76 trial results
reveal a reduction in perinatal transmission of
HIV from 25% to 7 % folllowing zidovudine
PRECAUTIONS:
• Frequent hand washing with soap and water
• Limiting attending staff
• Cuts and abrasions should be covered with
waterproof dressings
• All staff should wear disposable sterile gowns
over plastic aprons ,waterproof shoe covers and
gloves and goggles

14. OBSTRETIC PRECAUTIONS:
• Membranes left intact as long as possible
• Limit vaginal examinations
• Instrumental delivery to be avoided
• Linen to be collected in vessel with
hypochlorite solution
• After delivery floor must be mopped with
antiseptic
• Fumigate labour room
• Autoclave all instruments

15. MANAGEMENT
ANTIRETROVIRAL THERAPY
WHEN TO START?
• Immediately after detection
• Should be started irrespective of gestational
age,CD4 count and WHO clinical stage
WHOM TO START?
All pregnant and breastfeeding women with HIV

16. ART REGIMEN
FIRST LINE:
Tenofovir disoproxil fumarate 300 mg +
lamivudine 300 mg + efavirenz 600mg/ day
Newborn Hiv exposed should be started on 6
weeks of syrup nevirapine immediately after
birth and on cotrimoxazole prophylaxis at 6
weeks and is tested for HIV DNA PCR at 6
weeks

17. Newborn ARV regimens should be initiated as
close to the time of birth as possible within 6
to 12 hrs of delivery
For newborns at low risk of transmission – ZDV
for 4 weeks
Newborns at high risk – ZDV for 6weeks, 3TC
and NVP for 2 to 6 weeks upto 6 weeks of life
Newborns with HIV infection- ZDV
+ 3TC+ NVP (or) ZDV + 3 TC +RAL lifelong

18. Newborns at high risk include those born to
women with HIV who
• Have not received antepartum ARV drugs
• Have received only intrapartum ARV drugs
• Have primary HIV infection during pregnancy
or breastfeeding
The use of ARV drugs other than ZDV,
lamivudine and nevirapine cannot be used in
premature newborns

19. CAUSES OF RECURRENT PREGNANCY LOSS
MATERNAL: Diabetes, hypertension, Rh
incompatability
Endocrine- luteal phase defect(LPD), thyroid
dysfunction, polycythemia
Anatomical- cervical incompetance, uterine
malformations,leomyoma
Immunological- anti phospholipid syndrome
CHROMOSOMAL ABNORMALITIES
50% Of which have recurrent abortions

20. Agenesis of corpus callosum
• Microcephaly
• Megalocephaly
AICARDE syndrome common in females and
lethal in males
Common in sex linked, autosomal dominant and
autosomal recessive