HIV DURING PREGNANCY, this is very common and very dangerous disease during pregnancy. this is for medical and nursing student. i tried to make understand of students.

1. Preeti shukla
Lecturer
Rama college of nursing,
kanpur
Uttar pradesh

6. HISTORY
• First as a mysterious illness primarily infecting
gay men in urban areas in the United States.
But that’s not really the beginning.
• Before the disease’s first mention in 1982 in
the New York Times, people had been dying of
AIDS for at least a decade, though probably
not much longer.
• In Africa, HIV–the virus that causes AIDS–had
jumped from chimpanzees to humans
sometime early in the 20th century.

7. • In earliest known case of HIV-1 infection in
human blood is from a sample taken in 1959
from a man who’d died in Kinshasa in what
was then the Belgian Congo.

8. INTRODUCTION
• HIV is a virus that attacks cells in the immune
system (the body’s natural defence against
illness). The virus destroys a type of white
blood cell in the immune system called a T-
helper cell – also referred to as a CD4 cell –
and uses these cells to make copies of itself.

9. • A great majority (85%) of pregnant and
breastfeeding women living with HIV also
received ART, which not only protects their
health, but also ensures prevention of HIV
transmission to their newborns.

12. STAGES OF HIV INFECTION
Stage One (Primary )-
 Lasts for a few weeks
 Flu like illness (fever, diarrhea, weight loss,
swollen glands)

13. Stage Two (Clinically Asymptomatic Stage)-
Lasts for an average of ten years Free from
major symptoms (swollen glands)
Stage Three (Symptomatic stage)- HIV
Infection Over time immune system (lymphatic)
becomes severely damaged HIV mutates and
becomes stronger and destroys more T cells.

14. Stage Four ( Progressive stage)-
• Converted from HIV to AIDS
• T cell count drops to 200

15. Causes of HIV transmission
Sex without a condom
• having unprotected sex (meaning sex without
a condom) with someone who has HIV.
Sharing injecting equipment
• sharing needles, syringes or other equipment
used to prepare and inject drugs with someone
who has HIV.

16. Passed from mother-to-baby during
pregnancy, childbirth and breastfeeding
• a mother infected with HIV can pass the virus
to her baby via her blood during pregnancy
and birth, and through her breast milk when
breastfeeding.

17. Contaminated blood transfusions and
organ/tissue transplants
• receiving blood transfusions, blood products,
or organ/tissue transplants that are
contaminated with HIV. This risk is extremely
small because most countries test blood
products for HIV first.

19. HIV is spread when infected blood, semen,
vaginal fluids, or breast milk gets into the
bloodstream of another person through:
• Direct entry into a blood vessel
• Mucous linings, such as the vagina, rectum,
penis, mouth, eyes, or nose
• A break in the skin

20. • HIV is not spread through saliva (spit). You
can only get HIV if infected blood, semen,
vaginal fluids, or breast milk gets into your
body.
• HIV is spread in the following ways:
• Having vaginal, anal, or oral sex without using
a condom.
• Sharing needles, syringes, or works to inject
drugs, vitamins, hormones, steroids, or
medicines.

21. • Women with HIV infection can pass HIV to
their babies during pregnancy, delivery, and
breastfeeding.
• People who are exposed to blood and/or body
fluids at work, like health care workers, may
be exposed to HIV through needle-sticks or
other on-the-job exposures. It is also possible
to pass HIV through sharing needles for
piercing or tattooing

24. Acute symptoms of HIV in mothers
• Fever
• Swollen glands
• Sore throat
• Night sweats
• Muscle aches
• Headache
• Extreme tiredness
• Rash

25. Advanced symptoms of HIV and
AIDS
• As HIV progresses, symptoms can include:
• diarrhea
• nausea and vomiting
• weight loss
• severe headache
• joint pain
• muscle aches
• shortness of breath
• chronic cough
• trouble swallowing

26. • Burning in and around the vagina and vulva
• Pain during sex
• Painful urination
• Thick, white vaginal discharge

27. In the later stages, HIV can lead to:
• Short-term memory loss
• Mental confusion
• Coma

29. DIAGNOSIS
Different types of tests can help a doctor diagnose
HIV. Some tests cannot detect the virus in the early
stages.
• HIV tests include:
• Antibody tests: These detect the presence of HIV
antibodies, or immune system proteins, in blood
or saliva samples. Rapid and at-home tests are
usually antibody tests. They cannot detect HIV at
an early stage.
• Antigen/antibody tests: These detect HIV
antibodies and antigens, or viral components, in
the blood. Antigen/antibody tests also cannot
detect HIV at an early stage

30. • Nucleic acid tests: These look for the presence
of HIV’s genetic material in the blood, and
they can detect HIV at an early stage.
• Anyone who may have contracted the virus
and who has early symptoms may wish to
speak to a doctor about a nucleic acid test.

31. • Standard tests. These blood tests check for HIV
antibodies. Your body makes antibodies in
response to the HIV infection. These tests can't
detect HIV in the blood soon after infection
because it takes time for your body to make these
antibodies. It generally takes two to 8 weeks for
your body to produce antibodies, but in some
cases it can take up to six months.
• In standard tests, a small sample of your blood is
drawn and sent to a lab for testing. Some of the
standard tests use urine or fluids that are collected
from the mouth to screen for antibodies.

32. • In-home test kits. These kits -- there are two
available in the U.S. -- screen blood and saliva
for HIV antibodies. You can buy them at your
local store. The Home Access HIV-1 Test
System requires a small blood sample that is
collected at home and sent to a lab. The user,
who may remain anonymous, can get results
by phone in three business days.

33. Why Should Pregnant Women Be
Tested for HIV?
• Doctors recommend all pregnant women
get tested for HIV. Medications are
available to prevent the spread of the
virus to your unborn baby. In addition,
steps can be taken during delivery to
prevent spreading the infection. Some
studies show women can further reduce
the risk of spreading the virus to their
baby by having a cesarean section before
their water breaks

34. if their viral load is high or unknown. Moreover,
your health care provider can take steps to help
you stay healthy longer.

36. Treatment of HIV
• General principles - Antiretroviral therapy is
now the standard in the prevention of MTCT.
The goals in the use of antiretroviral drugs
during pregnancy are two fold:
(a) Treatment of maternal infection and
(b)Reduction of the risk of perinatal
transmission. Pregnant women meeting the
treatment criteria for other adults should be
offered standard HAART.

44. • If a women presents in labour, the
preferred intrapartum regimen is:
(a) IV ZDV (see Box 35.4) beginning at onset of
labour or three hours before elective CS.
(b) 3TC 150 mg po at onset of labour then 150
mg po q12h till delivery.
(c) NVP single dose 200 mg at onset of labour.

45. • After delivery, the mother should continue
ZDV/3TC for 7 days to reduce the development
of NNRTI resistance.
• The baby should continue to receive oral or IV
ZDV for 6 weeks plus a single dose NVP 2
mg/Kg at 48-72 h.
• For women presenting after delivery, there should
be immediate administration of ZDV (continued
for 6 weeks) and NVP to the neonate.
• This should be done as soon as possible. Initiation
of treatment after 48 h is normally not indicated,
and may contribute to viral resistance should
infection occur.

49. Special care during pregnancy and
childbirth
• If mother have HIV, mother will need extra
healthcare during pregnancy.
• This will include antiretroviral medicines,
possibly vaccines, and other preventive
treatments.
• Need to work with a healthcare provider who’s
trained in high-risk pregnancy, infectious
disease, or HIV.

50. • Mother will need regular blood tests to check
the amount of HIV in your body. Your HIV
should be completely controlled, or
"undetectable." This will help minimize the
risk of your baby picking up HIV.

51. • Vaginal birth can expose a baby to the HIV
virus, particularly if HIV is detectable. If that
is the case, talk with healthcare provider about
whether you should have a C-section
(cesarean) birth.
• C-section helps reduce the risk of spreading
the virus to your baby if your virus is not
completely under control with medicines.

52. Special care for your baby after birth
• Babies of mothers with HIV are watched
closely.
• Your baby will be given anti-HIV medicines
after birth.
• Your baby will have regular exams and blood
tests. In most cases, a diagnosis of HIV
infection can be made by the time a baby is 3
months old.

53. • Because HIV can be passed on through
breastmilk, you shouldn’t breastfeed your
baby. Talk with your healthcare provider about
formula feeding.

54. • Having a healthy baby
• The prevention of MTCT does not necessarily
equate a healthy baby. The health status of a
newborn may suffer on several fronts:
• (a) Negative impacts of maternal HIV disease -
HIV disease may confer a worsened pregnancy
outcome. This may be mediated through
associated risks such as drug use and poor access
to antenatal care as well as the disease itself.
• (b) Fetal exposure to antiretrovirals - While
potent antiretrovirals may decrease MTCT and
control maternal disease, the fetus may suffer
adverse effects and possible teratogenicity.

55. • (c) Expert paediatric care - The prevention of
MTCT does not stop at delivery. Expert
paediatric care has to be provided for optimal
continuation and monitoring of antiretrovirals,
establishment of HIV diagnosis, initiation of
PCP prophylaxis, and the supervision of
replacement feeding.

56. Maternal well-being
The quest for preventing the baby from HIV
infection should not compromise the welfare of
the mother. Potential dilemna may occur in the
following circumstances:
(a) continuation or initiation of antiretrovirals for
maternal disease in the first trimester of
pregnancy,
(b) use of antiretrovirals for prevention of MTCT
in a mother whose disease does not require
treatment yet,

57. • (c) the potential impacts of elective CS on
maternal morbidity, and
• (d) avoidance of breast feeding which is
important for maternal baby bonding.

59. The social and psychological impacts
• A diagnosis of maternal HIV infection carries
enormous social and psychological
implications, which arise largely as a result of
the stigma attached to the infection. The health
care provider is faced with the following
challenges:
(a) encouraging partner referral for HIV testing,
(b) preparing the mother for the dual challenge
of preventing transmission to the baby and
taking care of her own health,

60. • (c) enlisting support from social service
agencies, this is especially important for those
non-Chinese mother/couples where social
support is usually weak.
(d) creating a supportive environment for the
newborn baby, which poses a challenge also to
the sick mother, and
(e) the need to accomplish the above in a
relatively short time.

61. Abbreviation
• MTCV- mother to child transmission
• ZDV- Zidovudine
• NVC- Nevirapine
• 3TC- Lamivudine