The document outlines Option B+ for lifelong antiretroviral therapy (ART) for preventing mother-to-child transmission (PMTCT) of HIV, stating that all HIV-positive pregnant and breastfeeding women should receive ART, regardless of their CD4 count. It emphasizes the advantages of ART, including improved maternal health and reduced risk of transmission, as well as guidelines for initiating treatment and specific drug regimens. Additionally, it addresses considerations for women with TB and infants born to HIV-positive mothers regarding prophylactic treatment.

1. Nov 2010
National Centre for AIDS
and STD Control
Module 3 Session 1
Option B+ : Life-long Antiretroviral Therapy (ART)
for PMTCT

2. Nov 2010
National Centre for AIDS
and STD Control
Session 1 Objectives
• Describe about the Option B+ ( life-long ARV therapy
(ART) for Prevention of Mother to Child Transmission)
along with its advantages.
• List criteria for starting pregnant women and
breastfeeding mothers on life-long ARV therapy (ART).
• List the recommended ARV drugs for lifelong ART

3. Difference between Option B and Option B+
Option B
• Lifelong ART for life for all HIV-positive
pregnant and breastfeeding women,
regardless of CD4 count.
Option B+
• Only women with low CD4 counts or
advanced disease are eligible to receive
lifelong ART
• Women with higher CD4 counts take
medication as a prophylaxis from 14
weeks of pregnancy through childbirth
(non-breastfeeding) or until one week
after breastfeeding has stopped until the
child is one year.
• ART would be restarted when a woman
either becomes pregnant again or she
meets the criteria for initiating
treatment for her own health.

4. Nov 2010
National Centre for AIDS
and STD Control
Option B+ (Life-long ARV Therapy)
• Option B+ provides all HIV-positive pregnant or
breastfeeding women with antiretroviral drugs to prevent
mother-to-child transmission.
• A triple-drug regimen should be taken throughout
pregnancy, delivery, breastfeeding and continue for life,
regardless of CD4 count or clinical stage.

5. Nov 2010
National Centre for AIDS
and STD Control
Advantages of Lifelong ART
• Antiretroviral therapy (ART) during pregnancy and breastfeeding treats
maternal HIV.
• Improves the health of women as it delays disease progression. Also it
provides protection against transmission in current and future
pregnancies
• Decreases the risk of transmitting HIV to infant by reducing the
maternal viral load
• Sexual prevention benefits: its reduce sexual transmission of HIV to
sexual partners

6. Nov 2010
National Centre for AIDS
and STD Control
Starting ART during Pregnancy
• A pregnant woman should start treatment as soon as
possible, even during the 1st
trimester.
• Risks of ART toxicities are greatly outweighed by the
benefit to the health of both mother and baby.
• Early Testing of HIV among pregnant women helps in
early initiation of ART. This emphasizes offering HIV
testing in ANC, during labor, delivery and in post
natal care.

7. Nov 2010
National Centre for AIDS
and STD Control
If a woman already taking ART
becomes pregnant
• Continue ART,
• Consult ART clinician at the ART site and reveal the
pregnancy status.
• Sometime a change in regimen is needed.
• Her baby should receive six (twelve) weeks of
Nevirapine after birth.

8. Nov 2010
National Centre for AIDS
and STD Control
First-line ART for pregnant and breastfeeding
women

9. Commonly Used ARV drugs for PMTCT
TDF
Tenofovir
• Well tolerated
• Taken with or without food once daily
• Check creatinine and urinalysis at baseline and
every 1 months till 12 months, then 6 monthly.
3TC
Lamivudine
• Absorbed quickly
• Taken with or without food
EFV
Effavirenz
• Absorbed quickly
• Taken with or without food
• Dizziness, vivid night dreams, Night mares,
Hypersensitivity skin reactions

10. Commonly Used ARV drugs for PMTCT
ZDV
Zidovudine
• Absorbed quickly
• Well tolerated, with occasional nausea
• Taken with or without food
• Can cause anaemia
NVP
Nevirapine
• Absorbed quickly
• Long half life protects the infant
• Taken with or without food
• Can cause hepatotoxicity or skin/mucosal reaction
• Can cause viral resistance, if not discontinued
correctly
• Avoid use with Rifampicin (ATT)

11. Nov 2010
National Centre for AIDS
and STD Control
Special situations in women initiating ART-
(TB)
• 1st priority: treat TB
• Pregnant women can receive TB drugs and ART together, but risk of
adverse reaction and drug interactions is high.
• Start ART within 2 -8 weeks of starting ATT.
• If the woman is taking rifampicin for TB, the risk of liver toxicity and
drug-drug interactions with nevirapine is significant. Use EFV based
regimen.

12. Nov 2010
National Centre for AIDS
and STD Control
What ARVs should the baby receive if mother is
HIV Positive?
High risk infants are defined as those:
• Mothers on no ART or < 8 weeks of ART at delivery
• If VL is available
VL >1,000 copies/ml at or 4 weeks before delivery
• If VL not available
Newly diagnosed women at delivery or postpartum
Low risk Syp NVP for 6 weeks
Syp AZT for 6 weeks for infants of mothers exposed to NVP in
the past
High risk Dual Prophylaxis
AZT + NVP for 6 weeks or NVP for 12 weeks

13. Nov 2010
National Centre for AIDS
and STD Control
Nevirapine Prophyxasis Dose
Baby Nevirapine Dose from birth to 6 weeks:
• Birth weight <2.5 Kg (1ml) 10 mg once daily
• Birth weight >2.5 Kg (1.5ml) 15 mg once daily

14. Nov 2010
National Centre for AIDS
and STD Control
Special Considerations:
Women with HIV-2 Infection
• HIV-2 has been documented in Nepal.
• If a woman is known to have HIV-2 infection, she
should avoid use of NNRTIs (NVP or EFV) as these are
not effective.
• Either a protease inhibitor based regimen (using LPV/r)
or a triple NRTI (ZDV+3TC+ABC) should be used as ART.

15. Nov 2010
National Centre for AIDS
and STD Control
Key Points
• Life-long ARV therapy (ART) decrease the disease
progression in mother and reduces the risk of MTCT
in babies.
• It is very effective.
• ART should be started in pregnancy and continued
for life long.