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HIV INPREGNANCY
1. HIV IN PREGNANCY
INTRODUCTION
The human immunodeficiency virus (HIV) is a retrovirus, which, like
many other viruses, stores its genetic information as RNA rather than
as DNA (most other living things use DNA).
When HIV enters a human cell, it releases its RNA, and an enzyme
called reverse transcriptase makes a DNA copy of the HIV RNA. The
resulting HIV DNA is integrated into the infected cell’s DNA. This
process is the reverse of that used by human cells, which make an RNA
copy of DNA. Thus, HIV is called a retrovirus, referring to the reversed
(backward) process.
The first documented AIDS case was in 1981.Since then, about 35 million
people have died from illnesses related to the disease. Millions of children
have been orphaned because of it.
Now, combination drug treatments have turned AIDS into a long-term
disease that you can manage.
The reduction in mother-to-child transmission of human
immunodeficiency virus (HIV) is regarded as one of the most effective
public health initiatives in the United States. In the absence of treatment,
the risk of vertical transmission of HIV is as high as 25-30%. With the
implementation of HIV testing, counseling, antiretroviral medication,
delivery by cesarean section prior to onset of labor, and discouraging
breastfeeding, the mother-to-infant transmission has decreased to less
than 2% in the United States.
2. The guidelines on management of HIV in pregnancy and postpartum
were released on March 14, 2019, by the British HIV Association
(BHIVA).[1]
Screening
Pregnant women living with HIV should be offered peer support if it is
available.
Evaluation of antenatal and postnatal depression should be made at
booking, 4-6 weeks postpartum and 3-4 months postpartum.
Pregnant women diagnosed with HIV should be screened for sexual
health.
Complete HIV drug resistance testing before treatment is initiated except
in women presenting after 28 weeks.
Perform a CD4 cell count at the initiation of combination antiretroviral
therapy (cART) and an additional CD4 count at delivery.
For women who begin cART during pregnancy, perform an HIV viral
load 2-4 weeks after starting, at least once every trimester, at 36 weeks,
and at the time of delivery.
Perform liver function tests in women who begin cART during
pregnancy and again with each routine blood test.
If a patient has started cART during pregnancy and has not suppressed
plasma viral load to <50 HIV RNA copies/mL, recommend an
adherence review, resistance testing, therapeutic drug monitoring,
regimen optimization, and treatment intensification.
Antiretroviral Therapy (ART) During Pregnancy
Continue cART treatment for patients who are conceiving and on an
effective cART regimen.
Start ART during pregnancy and advise to continue lifelong treatment
for all pregnant women including elite controllers.
3. MINI SEMINAR ON HIV IN PREGNANCY
6 MAY 2019
PROGRAMME SCHEDULE
TIME TOPIC SPEAKER MODERATOR
10:00 -
10:30AM
INAUGURAL CEREMONY
10:30-11:00
AM
Anatomy &
mechanism of
HIV virus
Transmission
and Replication
MS. KRITIKA
INDORA
Mr.
ASHUTOSHA
SINGH
11:00 -11:20
AM
Management
during laborand
postnatal period
& immediate
new born care
Mr.
RAJENDRAPAL
MS.REKHA
RAWAT
11:20-
11:40AM
ART Centre
setup & role of
staff
MS.KHUSHBOO
RAWAT
MS. SAVITA
11:40-
12:05PM
ART therapy MS. MAYURI
KACHHOT
MS. AYUSHI
12:05-
12:30PM
BREAK
12:30-
01:00PM
Prevention to
HIV infection
Mr.
PRADHUMAN
SINGH
Mr.ASHUTOSHA
![The guidelines on management of HIV in pregnancy and postpartum
were released on March 14, 2019, by the British HIV Association
(BHIVA).[1]
Screening
Pregnant women living with HIV should be offered peer support if it is
available.
Evaluation of antenatal and postnatal depression should be made at
booking, 4-6 weeks postpartum and 3-4 months postpartum.
Pregnant women diagnosed with HIV should be screened for sexual
health.
Complete HIV drug resistance testing before treatment is initiated except
in women presenting after 28 weeks.
Perform a CD4 cell count at the initiation of combination antiretroviral
therapy (cART) and an additional CD4 count at delivery.
For women who begin cART during pregnancy, perform an HIV viral
load 2-4 weeks after starting, at least once every trimester, at 36 weeks,
and at the time of delivery.
Perform liver function tests in women who begin cART during
pregnancy and again with each routine blood test.
If a patient has started cART during pregnancy and has not suppressed
plasma viral load to <50 HIV RNA copies/mL, recommend an
adherence review, resistance testing, therapeutic drug monitoring,
regimen optimization, and treatment intensification.
Antiretroviral Therapy (ART) During Pregnancy
Continue cART treatment for patients who are conceiving and on an
effective cART regimen.
Start ART during pregnancy and advise to continue lifelong treatment
for all pregnant women including elite controllers.](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)