The document discusses reducing mother-to-child transmission of HIV, which occurs during pregnancy, labor and delivery, and breastfeeding. Studies show that antiretroviral regimens like zidovudine administered to mothers and infants can reduce transmission rates. Proper obstetric practices and counseling of mothers on prevention and treatment options are important for lowering pediatric HIV infection.
This was a lecture given during the CME activitiy for POGS Region 7 by the Philippine Infectious Disease Society for Obstetrics and Gynecology (PIDSOG) at Casino Espanyol in Cebu City.
This document provides statistics on the global HIV epidemic in 2018 from UNAIDS as well as information on HIV in India. Some key points:
- 37.9 million people globally were living with HIV in 2018. 1.7 million became newly infected that year while 23.3 million were accessing antiretroviral therapy.
- India has the third largest HIV epidemic in the world. In 2015, the national adult prevalence was 0.26%. Prevalence is highest in certain states like Mizoram (2.04%) and Manipur (1.43%).
- Children account for 6.54% of total PLHIV in India. Early infant diagnosis, appropriate infant feeding and prophylaxis
World AIDS Day
World AIDS Day is held on 1 December each year. It raises awareness across the world and in the community about the issues surrounding HIV and AIDS. It is a day for people to show their support for people living with HIV and to commemorate people who have died.
During last two decades understanding and treatment of HIV-infected persons and lab techniques for the preparation of virus-free sperms have improved substantially.
Current treatments for HIV can limit the risk of viral transmission to the partner and offspring. Now a days more and more HIV infected couples are seeking fertility options.
A talk delivered by Dr Neelam Ohri in centenary program in BHU, Varanasi, on HIV and Infertility.
I delivered this talk in a HIV awareness workshop in BHU centenary celebration, BHU, Varanasi U.P. India
During last two decades understanding and treatment of HIV-infected persons and lab techniques for the preparation of virus-free sperms have improved substantially.
Current treatments for HIV can limit the risk of viral transmission to the partner and offspring.
Infertility treatment in
Sero discordant couple
Sero concordant couple
Knowingly conceiving a child who may be born with HIV
HIV testing for couples seeking fertility assistance
Potential risks to the health- care providers
Improving access to infertility care for HIV-infected individuals
Providing third party assisted reproductive services
This document summarizes HIV/AIDS during pregnancy. It discusses how HIV causes AIDS by depleting CD4 cells. Around 25-30% of people with HIV worldwide are women aged 20-49. The document outlines how HIV is transmitted from mother to child, mainly during labor and delivery. It recommends offering HIV testing to all pregnant women and treating HIV-positive mothers with antiretroviral therapy to reduce the risk of transmission to less than 2%. Safety measures during pregnancy, delivery and postpartum are also discussed.
This document summarizes guidelines for preventing mother-to-child transmission (PMTCT) of HIV. It discusses how HIV can be transmitted from mother to child during pregnancy, delivery, and breastfeeding. The overall transmission rate without intervention is 15-45%, which can be reduced below 5% with effective interventions. These include voluntary counseling and testing for pregnant women, access to antiretroviral treatment for HIV-positive mothers and their infants, safe delivery practices, and guidance on infant feeding options. The document provides details on testing and treatment recommendations during the antenatal, intrapartum, and postpartum periods to reduce HIV transmission from mother to child.
This was a lecture given during the CME activitiy for POGS Region 7 by the Philippine Infectious Disease Society for Obstetrics and Gynecology (PIDSOG) at Casino Espanyol in Cebu City.
This document provides statistics on the global HIV epidemic in 2018 from UNAIDS as well as information on HIV in India. Some key points:
- 37.9 million people globally were living with HIV in 2018. 1.7 million became newly infected that year while 23.3 million were accessing antiretroviral therapy.
- India has the third largest HIV epidemic in the world. In 2015, the national adult prevalence was 0.26%. Prevalence is highest in certain states like Mizoram (2.04%) and Manipur (1.43%).
- Children account for 6.54% of total PLHIV in India. Early infant diagnosis, appropriate infant feeding and prophylaxis
World AIDS Day
World AIDS Day is held on 1 December each year. It raises awareness across the world and in the community about the issues surrounding HIV and AIDS. It is a day for people to show their support for people living with HIV and to commemorate people who have died.
During last two decades understanding and treatment of HIV-infected persons and lab techniques for the preparation of virus-free sperms have improved substantially.
Current treatments for HIV can limit the risk of viral transmission to the partner and offspring. Now a days more and more HIV infected couples are seeking fertility options.
A talk delivered by Dr Neelam Ohri in centenary program in BHU, Varanasi, on HIV and Infertility.
I delivered this talk in a HIV awareness workshop in BHU centenary celebration, BHU, Varanasi U.P. India
During last two decades understanding and treatment of HIV-infected persons and lab techniques for the preparation of virus-free sperms have improved substantially.
Current treatments for HIV can limit the risk of viral transmission to the partner and offspring.
Infertility treatment in
Sero discordant couple
Sero concordant couple
Knowingly conceiving a child who may be born with HIV
HIV testing for couples seeking fertility assistance
Potential risks to the health- care providers
Improving access to infertility care for HIV-infected individuals
Providing third party assisted reproductive services
This document summarizes HIV/AIDS during pregnancy. It discusses how HIV causes AIDS by depleting CD4 cells. Around 25-30% of people with HIV worldwide are women aged 20-49. The document outlines how HIV is transmitted from mother to child, mainly during labor and delivery. It recommends offering HIV testing to all pregnant women and treating HIV-positive mothers with antiretroviral therapy to reduce the risk of transmission to less than 2%. Safety measures during pregnancy, delivery and postpartum are also discussed.
This document summarizes guidelines for preventing mother-to-child transmission (PMTCT) of HIV. It discusses how HIV can be transmitted from mother to child during pregnancy, delivery, and breastfeeding. The overall transmission rate without intervention is 15-45%, which can be reduced below 5% with effective interventions. These include voluntary counseling and testing for pregnant women, access to antiretroviral treatment for HIV-positive mothers and their infants, safe delivery practices, and guidance on infant feeding options. The document provides details on testing and treatment recommendations during the antenatal, intrapartum, and postpartum periods to reduce HIV transmission from mother to child.
Approximately 8,500 women living with HIV give birth annually in the US. Since the beginning of the AIDS epidemic, almost 5,000 children under age 13 who got HIV through perinatal transmission have died. New HIV infections in children have dramatically declined from 400,000 in 2009 to around 220,000 in 2014 due to efforts like the UNICEF Global Plan. Prevention of perinatal transmission is crucial since there is no HIV vaccine; it requires pregnant women to take antiretroviral therapy consistently during and after pregnancy and avoid breastfeeding. Challenges to prevention include not all pregnant women knowing their HIV status and inconsistent access to treatment.
Vertical transmission is major contributor- HIV among children
No intervention – as high as 45%
With interventions – as low as less than 5%
Minimal manipulation
NVD vs. C-section
Anti retroviral prophylaxis vs. anti retroviral therapy
Exclusive breastfeeding vs. exclusive replacement feeding
Follow-up and care.
This document discusses HIV/AIDS in pregnancy and prevention of mother-to-child transmission (PMTCT) of HIV in Nigeria. It provides statistics on the burden of HIV in Nigeria and describes the primary mode of HIV transmission as sexual contact. It then focuses on mother-to-child transmission, risk factors that increase transmission during pregnancy and delivery, and the benefits of PMTCT for both mother and infant. It also outlines recommended testing, treatment and prevention strategies used in PMTCT programs.
Prevention of Mother to Child Transmission of HIV 2018Helen Madamba
Babies of pregnant women living with HIV can be born free of HIV infection. HIV counselling and testing is the gateway to diagnosis, treatment, care and support. Healthcare services need to provide enabling environments to support and empower women living with HIV and their children, to increase HIV knowledge and reduce stigma and discrimination.
This document provides guidelines for managing HIV infection in pregnancy. It discusses counseling pregnant women who test positive for HIV, antenatal care including investigations and treatment with antiretroviral therapy, preventing mother-to-child transmission through medication and delivery methods, care during labor and delivery, testing and treatment for infants, and postpartum care of both mother and baby. The goal is to reduce the risk of transmitting HIV from mother to child to less than 2% through screening, testing, antiretroviral treatment, and modifying delivery and infant feeding practices.
This lecture describes the approach to screening, diagnosis and management of HIV and TB infection among pregnant patients. Prevention of Mother to Child Transmission of HIV infection mainly based on the Philippine Obstetrical and Gynecological Society Clinical Practice Recommendations.
This document discusses strategies to eliminate mother-to-child transmission of HIV, including testing and treatment during pregnancy. It notes that transmission can be reduced to less than 1% with appropriate medical treatment. Globally, over 1,000 babies are born with HIV daily due to lack of treatment. The risks and benefits of various antiretroviral regimens during pregnancy are analyzed. Combination antiretroviral therapy is recommended to reduce transmission risk and maintain viral suppression.
1) HIV infection during pregnancy poses risks for both mother and baby, with around 13,000 babies born to HIV+ mothers becoming infected each year in India.
2) Strategies to prevent mother-to-child transmission include antiretroviral therapy for the mother during pregnancy and delivery, and for 6 weeks postpartum. Caesarean delivery and avoiding breastfeeding can further reduce risks of transmission.
3) Proper prenatal counseling, treatment, and testing of the newborn are important for management of HIV infection during pregnancy.
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. HIV attacks T-cells in the immune system, leading to AIDS in advanced stages. Children progress more rapidly than adults, with half of untreated children dying within 2 years.
2. In India, around 2.4 million people live with HIV, with 25,000 new infections annually in children, most occurring during pregnancy or birth. Approximately 5,000 infected children progress to AIDS each year.
3. HIV is diagnosed through PCR testing in children under 18 months or antibody testing along with clinical symptoms in older children. Management includes cotrimoxazole prophylaxis, antiretroviral therapy, treatment of opportunistic infections, adequate nutrition and immunization.
This document provides information on PMTCT (Prevention of Mother-To-Child Transmission) of HIV. It defines key terms and provides global and local HIV statistics. Globally in 2022, 39 million people lived with HIV, with 1.3 million newly infected that year. In Ghana, 346,120 people live with HIV and the prevalence is 1.7% among ages 15-49, though higher for females. Without intervention, mother-to-child transmission of HIV during pregnancy and breastfeeding accounts for most HIV infections in children under 15. PMTCT interventions can reduce this risk to below 5%.
1) Unsafe abortions are a major reproductive health challenge, accounting for 24 million procedures and over 360,000 deaths annually.
2) Lack of access to contraception and family planning services, as well as social factors like poverty, early marriage, and gender inequality contribute to high rates of unwanted pregnancy and unsafe abortion.
3) Improving access to contraception, comprehensive sexuality education, and safe abortion and post-abortion care services can help reduce maternal mortality from unsafe abortion and advance progress on Millennium Development Goal 5 of improving maternal health.
1) The document discusses eliminating pediatric HIV/AIDS through preventing mother-to-child transmission (PMTCT). It outlines the four components of the WHO's PMTCT strategy and improvements in reducing new HIV infections among children from 600,000 in 1990 to 370,000 in 2009.
2) While PMTCT programs have expanded, only about half of pregnant women and infants receive antiretroviral drugs. Early diagnosis and lifelong treatment are critical for infants to survive.
3) Goals for HIV care programs include preventing opportunistic infections, early identification and management of complications, and engaging patients in care, treatment and prevention through education and support. With continued progress, the document argues that virtual elimination of pediatric HIV
This document discusses updates on the HIV epidemic globally and in the US and Philippines. It notes that while prevalence of HIV is declining in the US, it is increasing rapidly in key populations in the Philippines. It also reviews best practices for testing, treatment, prevention of mother-to-child transmission, management of coinfections, and prevention and treatment of opportunistic infections for those living with HIV. Barriers to controlling the epidemic like stigma and lack of awareness are also addressed.
HIV in pregnancy latest update 2020-Dr Zharif.pptxQuekRouYing
This document discusses HIV in pregnancy, including how HIV affects pregnancy and vice versa. It covers mother-to-child transmission of HIV, the importance of antiretroviral treatment during pregnancy to prevent transmission, and recommendations for care during pre-pregnancy, antenatal, intrapartum, and postpartum periods. Key points include initiating ART for all HIV+ pregnant women, close monitoring for drug side effects, modes of delivery depending on viral load, and continuing ART after delivery to reduce risk of mother-to-child HIV transmission to less than 2%.
HIV and other infectious diseases affecting pregnancy
1) HIV, urinary tract infections, hepatitis B, and group B streptococcus are important infectious diseases that can affect pregnancy. 2) Managing HIV-infected pregnancies involves confirming the diagnosis, counseling, treatment, monitoring the mother and fetus, delivery, and postpartum care. 3) Treatment goals are to preserve the mother's health, prevent perinatal HIV transmission, and ensure the health of the fetus and neonate.
1. The document discusses prevention of parent-to-child transmission (PPTCT) of HIV, including that transmission can occur during pregnancy, labor, delivery and breastfeeding. It also discusses the importance of PPTCT for preventing pediatric HIV infections.
2. PPTCT services in India aim to detect positive pregnant women and provide them comprehensive services including antiretroviral treatment (ART). The objectives are to detect over 80% of positive women, provide services to over 90%, and ensure over 95% ART compliance for positive women.
3. Care for HIV exposed infants includes care at birth, infant feeding support, antiretroviral prophylaxis, vaccines, cotrimoxazole
STIs.pptx medicine and nursing powerpoit1901600146
The document discusses sexually transmitted infections (STIs). It defines STIs as diseases transmitted through sexual contact. Common STIs are caused by bacteria, viruses, fungi, protozoa, and parasites. The document then discusses specific STIs in detail, including their causes, symptoms, treatments, and prevention methods. It provides clinical guidelines for diagnosing and managing STIs like syphilis, HIV/AIDS, and others.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Approximately 8,500 women living with HIV give birth annually in the US. Since the beginning of the AIDS epidemic, almost 5,000 children under age 13 who got HIV through perinatal transmission have died. New HIV infections in children have dramatically declined from 400,000 in 2009 to around 220,000 in 2014 due to efforts like the UNICEF Global Plan. Prevention of perinatal transmission is crucial since there is no HIV vaccine; it requires pregnant women to take antiretroviral therapy consistently during and after pregnancy and avoid breastfeeding. Challenges to prevention include not all pregnant women knowing their HIV status and inconsistent access to treatment.
Vertical transmission is major contributor- HIV among children
No intervention – as high as 45%
With interventions – as low as less than 5%
Minimal manipulation
NVD vs. C-section
Anti retroviral prophylaxis vs. anti retroviral therapy
Exclusive breastfeeding vs. exclusive replacement feeding
Follow-up and care.
This document discusses HIV/AIDS in pregnancy and prevention of mother-to-child transmission (PMTCT) of HIV in Nigeria. It provides statistics on the burden of HIV in Nigeria and describes the primary mode of HIV transmission as sexual contact. It then focuses on mother-to-child transmission, risk factors that increase transmission during pregnancy and delivery, and the benefits of PMTCT for both mother and infant. It also outlines recommended testing, treatment and prevention strategies used in PMTCT programs.
Prevention of Mother to Child Transmission of HIV 2018Helen Madamba
Babies of pregnant women living with HIV can be born free of HIV infection. HIV counselling and testing is the gateway to diagnosis, treatment, care and support. Healthcare services need to provide enabling environments to support and empower women living with HIV and their children, to increase HIV knowledge and reduce stigma and discrimination.
This document provides guidelines for managing HIV infection in pregnancy. It discusses counseling pregnant women who test positive for HIV, antenatal care including investigations and treatment with antiretroviral therapy, preventing mother-to-child transmission through medication and delivery methods, care during labor and delivery, testing and treatment for infants, and postpartum care of both mother and baby. The goal is to reduce the risk of transmitting HIV from mother to child to less than 2% through screening, testing, antiretroviral treatment, and modifying delivery and infant feeding practices.
This lecture describes the approach to screening, diagnosis and management of HIV and TB infection among pregnant patients. Prevention of Mother to Child Transmission of HIV infection mainly based on the Philippine Obstetrical and Gynecological Society Clinical Practice Recommendations.
This document discusses strategies to eliminate mother-to-child transmission of HIV, including testing and treatment during pregnancy. It notes that transmission can be reduced to less than 1% with appropriate medical treatment. Globally, over 1,000 babies are born with HIV daily due to lack of treatment. The risks and benefits of various antiretroviral regimens during pregnancy are analyzed. Combination antiretroviral therapy is recommended to reduce transmission risk and maintain viral suppression.
1) HIV infection during pregnancy poses risks for both mother and baby, with around 13,000 babies born to HIV+ mothers becoming infected each year in India.
2) Strategies to prevent mother-to-child transmission include antiretroviral therapy for the mother during pregnancy and delivery, and for 6 weeks postpartum. Caesarean delivery and avoiding breastfeeding can further reduce risks of transmission.
3) Proper prenatal counseling, treatment, and testing of the newborn are important for management of HIV infection during pregnancy.
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. HIV attacks T-cells in the immune system, leading to AIDS in advanced stages. Children progress more rapidly than adults, with half of untreated children dying within 2 years.
2. In India, around 2.4 million people live with HIV, with 25,000 new infections annually in children, most occurring during pregnancy or birth. Approximately 5,000 infected children progress to AIDS each year.
3. HIV is diagnosed through PCR testing in children under 18 months or antibody testing along with clinical symptoms in older children. Management includes cotrimoxazole prophylaxis, antiretroviral therapy, treatment of opportunistic infections, adequate nutrition and immunization.
This document provides information on PMTCT (Prevention of Mother-To-Child Transmission) of HIV. It defines key terms and provides global and local HIV statistics. Globally in 2022, 39 million people lived with HIV, with 1.3 million newly infected that year. In Ghana, 346,120 people live with HIV and the prevalence is 1.7% among ages 15-49, though higher for females. Without intervention, mother-to-child transmission of HIV during pregnancy and breastfeeding accounts for most HIV infections in children under 15. PMTCT interventions can reduce this risk to below 5%.
1) Unsafe abortions are a major reproductive health challenge, accounting for 24 million procedures and over 360,000 deaths annually.
2) Lack of access to contraception and family planning services, as well as social factors like poverty, early marriage, and gender inequality contribute to high rates of unwanted pregnancy and unsafe abortion.
3) Improving access to contraception, comprehensive sexuality education, and safe abortion and post-abortion care services can help reduce maternal mortality from unsafe abortion and advance progress on Millennium Development Goal 5 of improving maternal health.
1) The document discusses eliminating pediatric HIV/AIDS through preventing mother-to-child transmission (PMTCT). It outlines the four components of the WHO's PMTCT strategy and improvements in reducing new HIV infections among children from 600,000 in 1990 to 370,000 in 2009.
2) While PMTCT programs have expanded, only about half of pregnant women and infants receive antiretroviral drugs. Early diagnosis and lifelong treatment are critical for infants to survive.
3) Goals for HIV care programs include preventing opportunistic infections, early identification and management of complications, and engaging patients in care, treatment and prevention through education and support. With continued progress, the document argues that virtual elimination of pediatric HIV
This document discusses updates on the HIV epidemic globally and in the US and Philippines. It notes that while prevalence of HIV is declining in the US, it is increasing rapidly in key populations in the Philippines. It also reviews best practices for testing, treatment, prevention of mother-to-child transmission, management of coinfections, and prevention and treatment of opportunistic infections for those living with HIV. Barriers to controlling the epidemic like stigma and lack of awareness are also addressed.
HIV in pregnancy latest update 2020-Dr Zharif.pptxQuekRouYing
This document discusses HIV in pregnancy, including how HIV affects pregnancy and vice versa. It covers mother-to-child transmission of HIV, the importance of antiretroviral treatment during pregnancy to prevent transmission, and recommendations for care during pre-pregnancy, antenatal, intrapartum, and postpartum periods. Key points include initiating ART for all HIV+ pregnant women, close monitoring for drug side effects, modes of delivery depending on viral load, and continuing ART after delivery to reduce risk of mother-to-child HIV transmission to less than 2%.
HIV and other infectious diseases affecting pregnancy
1) HIV, urinary tract infections, hepatitis B, and group B streptococcus are important infectious diseases that can affect pregnancy. 2) Managing HIV-infected pregnancies involves confirming the diagnosis, counseling, treatment, monitoring the mother and fetus, delivery, and postpartum care. 3) Treatment goals are to preserve the mother's health, prevent perinatal HIV transmission, and ensure the health of the fetus and neonate.
1. The document discusses prevention of parent-to-child transmission (PPTCT) of HIV, including that transmission can occur during pregnancy, labor, delivery and breastfeeding. It also discusses the importance of PPTCT for preventing pediatric HIV infections.
2. PPTCT services in India aim to detect positive pregnant women and provide them comprehensive services including antiretroviral treatment (ART). The objectives are to detect over 80% of positive women, provide services to over 90%, and ensure over 95% ART compliance for positive women.
3. Care for HIV exposed infants includes care at birth, infant feeding support, antiretroviral prophylaxis, vaccines, cotrimoxazole
STIs.pptx medicine and nursing powerpoit1901600146
The document discusses sexually transmitted infections (STIs). It defines STIs as diseases transmitted through sexual contact. Common STIs are caused by bacteria, viruses, fungi, protozoa, and parasites. The document then discusses specific STIs in detail, including their causes, symptoms, treatments, and prevention methods. It provides clinical guidelines for diagnosing and managing STIs like syphilis, HIV/AIDS, and others.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. 2
What Is HIV/AIDS?
• Acquired immunodeficiencysyndrome (AIDS) is caused
by the humanimmunodeficiencyvirus (HIV).
• HIV attacks and destroys whiteblood cells, causinga
defect in thebody’s immunesystem.
3. 3
What Is HIV/AIDS?
• The immunesystem of an HIV-infectedperson becomes
so weakenedthatit cannotprotect itself from serious
infections. Whenthishappens, theperson clinically has
AIDS.
• AIDS may manifestas early as 2 years or as late as 10
years after infectionwith HIV.
4. 4
Number ofPeoplewith
HIV/AIDSby Region
North America
890,000
Caribbean
330,000
Latin
America
1.4 million
Western Europe
500,000
Sub-Saharan
Africa
22.5 million
Eastern Europe &
Central Asia
270,000 East Asia
& Pacific
560,000
South and
South East Asia
6.7 million
Australia and New Zealand
12,000
North Africa &
Middle East
210,000
Source: UNAIDS/WHO 1998.
5. 5
HIV Transmission Through SexualContact
• Of every 100 HIV infectedadults, 75-85 have been
infectedthrough unprotected intercourse
– 70% of these infections are from heterosexual intercourse
• STDs, especially ulcerative lesions in genitalia,increase
risk of transmission
Source: UNAIDS/WHO 1996.
6. 6
Modesof HIV Transmission
• Sexualintercourse
• Accidental exposure to blood/blood products (e.g.,
blood transfusions,shared needles, contaminated
instruments)
• Mother to childduring:
– pregnancy
– birth
– breastfeeding
7. 7
Womenand HIV
Social Risk Factors
– Illiteracy
– Lackof awarenessof preventive measures
Biological risk factors
– Twiceas easy for women to contract HIVfrom men
– Physiology of women (e.g., menstruation, intercourse)
– Pregnancy-associated conditions (e.g., anemia, menorrhagia and
hemorrhage) increase the need for blood transfusion
8. 8
HIV andContraception
• Contraception withprotection
– Male condom (latex and vinyl)
– Female condom
– Nonoxynol-9 (antiviralspermicidal cream)1
– Diaphragm1
• Methods appropriate for use by womenwith HIV. They should
use a condom for their partner’s protection.
– Hormonals (COCs, Implants, PICs)
– Voluntary sterilization
1Partial protection if used without condom
10. 10
HIV Transmission from Mother toInfant
• Antenatal
– In utero bytransplacentalpassage
• Intranatal
– Exposure to maternal blood and vaginalsecretions during labor
and delivery
• Postnatal
– Postpartum through breastfeeding
Source: UNAIDS/WHO 1996; UNAIDS/WHO 1998.
11. 11
HIV Transmission from Mother toInfant
• 25-35% of all infantsborn to HIV-infected womenin
developing countriesbecome infected
• 90% of HIV-infectedinfantsand children were infectedby
mother
Source: UNAIDS/WHO 1996; UNAIDS/WHO 1998.
12. • approximately 600,000 HIV-infected infants
are born every year–at least 1,600 every
day–in resource-constrained countries.
• Transmission occurs during pregnancy,
labor and delivery, and breastfeeding.
• The rate of mother to child transmission has
been reduced to less than 5 percent
among the limited number of HIV-infected
women in developed countries.
13. • high rates are largely due to
the lack of access to:
–HIV voluntary counseling and
testing
– replacement feeding
–selective caesarean section
–antiretroviral drug therapy
14. 14
HIV Transmission
HIV cannot be transmittedby:
– Casualperson to person contact at home or work or in socialor
public places
– Food, air, water
– Insect/mosquito bites
– Coughing, sneezing, spitting
– Shakinghands, touching, dry kissingor hugging
– Swimming pools, toilets, etc.
15. 15
AIDSand Infants
• Symptoms generallydevelop by 6 monthsof age
– Diarrhea
– Failure to thrive
• Most of thesechildren diebefore their second birthday
• Children born to HIV-infected parents are likely to become
orphans
16. Reducing pediatric HIV infection
and disease involves three
stages:
• preventing HIV infection among women of
childbearing age
• preventing unwanted pregnancy among
HIV-positive women
• preventing mother to child transmission
during pregnancy, labor and delivery, and
breastfeeding
17. BENEFITS TO HIV TESTING
• EARLY COUNSELING AND
TREATMENT OF HIV INFECTION
• ABILITY TO MAKE DECISIONS
REGARDING PREGNANCY
• IMPLEMENTATION OF STRATEGIES
TO ATTEMPT TO PREVENT
TRANSMISSION TO FETUS
18. WHO SHOULD WE
SCREEN?
• ALL PREGNANT WOMEN
• TARGETED TESTING FAILS TO
IDENTIFY A SUBSTANTIAL
PROPORTION OF HIV POSITIVE
WOMEN
19. • zidovudine (AZT) administered to the
mother from 14 weeks of gestation and
to the child during the first seven days
after birth, reduced the risk of mother to
child transmission among non-
breastfeeding mothers by two-thirds.
• Two similar studies conducted in Côte
d’Ivoire and Burkina Faso among
breastfeeding mothers demonstrated a
37 percent reduction in mother to child
transmission.
Anti-Retroviral Based Prevention Strategies
20. • A study in Uganda demonstrated a 47
percent reduction in mother to child
transmission following the
administration of a single dose of
nevirapine to the mother at onset of
labor and to the baby within 72 hours
after birth.
• The combination of AZT and lamivudine
in a short-course regimen also has been
shown to reduce mother to child
transmission.
Anti-Retroviral Based Prevention Strategies
21. 21
Protecting HealthCareWorkersDuring Labor
and Delivery
• Precautionsduringlabor:
– Protection from blood and amniotic fluids
– Protection from sharp instruments
• Resuscitationof baby:
– Nomouth to mouth suction
– Nomouth to mouth breathing
• Precautionsfollowinglabor:
– Proper disinfection of instruments
– Proper disposal of placenta and other items
22. PRETEST COUNSELING
• TAKE RISK HISTORY AND COUNCIL
REGARDING RISK REDUCTION
• DISCUSS REASONS FOR TEST
• PROVIDE INFORMATION TO WOMEN
REGARDING TESTING & ILLNESS
• RISKS & BENEFITS OF TESTING
• CONFIDENTIALITY OF RESULTS
• ASSESS WINDOW PERIOD
• PERSON HAS RIGHT TO REFUSE
TESTING
23. POST-TEST COUNSELING
• HIV RESULTS SHOULD BE GIVEN IN
PERSON
• ASSESS PATIENT’S UNDERSTANDING
• ENCOURAGE PATIENT TO EXPRESS
FEELINGS AND ASK QUESTIONS
• NEGATIVE AND INDETERMINATE
RESULTS: DISCUSS NEED FOR REPEAT
TESTING
24. POSITIVE RESULT
• IDENTIFY IMMEDIATE CONCERNS
• IDENTIFY SUPPORTS
• EFFECT OF HIV ON PREGNANCY
• RISK OF TRANSMISSION TO FETUS
DURING PREGNANCY, L&D, BF
• MEASURES TO DECREASE HIV
TRANSMISSION
25. CONCLUSIONS
• ALLPREGNANTWOMEN SHOULD BE
OFFERRED HIV TESTING
• PRE- & POST- TEST COUNSELING FOR
ALL PREGNANTWOMEN
• TARGETED TESTING OF PREGNANT
WOMEN WHO REPORT HIGH RISK
BEHAVIOR NOT RECOMMENDED
28. ANTENATAL CARE
• SIMILAR TO CARE FOR HIV NEGATIVE
WOMEN
• PREGNANCY NOT HIGH RISK
• SAME NUMBER OF ANTENATAL VISITS
• AVOID INVASIVE ANTENATAL TESTS OR
PROCEDURES
29. FIRST VISIT
• PATIENT HISTORY
• DATES OF 1ST POSITIVE HIV TEST
• HIV RISK FACTORS
• HIV CARE AT TIME OF CONCEPTION
• SEROLOGIC STATUS OF PARTNER
• OTHER STD’S
• OPPORTUNISTIC INFECTIONS
• DRUG HISTORY
30. FIRST VISIT
• INVESTIGATIONS
• CBC & DIFFERENTIAL
• LYTES, GLUCOSE, RFT’S, LFT’S, LIVER
ENZYMES
• CD4+ COUNT, CD8 COUNT, CD4/CD8
• VIRAL LOAD
• SEROLOGY FOR HEP A, B, C, SYPHILIS,
RUBELLA, TOXO, CMV
• TB SKIN TEST
31. FOLLOW UP VISITS
• STANDARD OBSTETRICAL ROUTINE
• INCREASE SURVEILLANCE ONLY IF
WARRANTED
• LABS EVERY 3 MONTHS
• CD4+ COUNT
• VIRAL LOAD
• SEROLOGY FOR TOXOPLASMOSIS AND
SYPHILIS
32. OPPORTUNISTIC
INFECTIONS
• PROPHYLAXIS SHOULD BE
OFFERED IN PREGNANCY FOR THE
FOLLOWING
• PNEUMOCYSTIS CARINII PNEUMONIA
• TOXOPLASMOSIS
• TUBERCULOSIS
• MYCOBACTERIUM AVIUM COMPLEX
• VARICELLA ZOSTER
• HEPATITIS A, B
33. CONCLUSION
• HIV IN PREGNANCY SHOULD BE
MANAGED BY MULTIDISCIPLINARY
TEAM
• ANTENATAL CARE IS SIMILAR TO
THAT OF HIV POSITIVE WOMEN
• PREGNANCY NOT CONSIDERED
HIGH RISK SIMPLY BY VIRTUE OF
HIV INFECTION
35. ANTEPARTUM
ANTIRETROVIRAL USE
• GOALS:
– CONTROL DISEASE IN MOTHER
– REDUCE PERINATAL TRANSMISSION
• VERY LITTLE DATA AVAILABLE ON
EFFECTS IN PREGNANCY
• MOST DATA ASSESSES ZIDOVUDINE
• LITTLE DATA ON OTHER DRUGS
36. CONCLUSIONS
• ZIDOVUDINE REDUCES PERINATAL
TRANSMISSION IN WOMEN AT
DIFFERENT STAGES OF DISEASE
• LONG AS WELL AS SHORTER
REGIMENS EFFECTIVE
• STILL EFFECTIVE IN
BREASTFEEDING POPULATIONS
• USE OF OTHER ANTIRETROVIRALS
IN COMBINATION WITH ZDV
PROMISING, STILL
39. IN UTERO EXPOSURE
B
Not teratogenic
Nelfinavir
C
Increased
hyperbilirubinemia
in monkeys -
neonatal
Incr.
supranumery &
cervical ribs
Indinavir
B
Not teratogenic
Saquinav
ir
B
Slight incr. in
cryptorchidism
Ritonavir
FDA
Pregnancy
Category
Non Teratogenic
Effects
Teratogenicity in
Animals
Drug
PI’s
41. IV ZIDOVUDINE
• ZDV LOADING DOSE AT ONSET OF
LABOR 2MG/KG OVER 1 HR
• CONTINUOUS INFUSION WHILE IN
LABOR 1MG/KG/HR
42. • INCREASING EVIDENCE THAT MOST
PERINATAL TRANSMISSION
OCCURS NEAR TIME OF OR DURING
DELIVERY
• REDUCTION OF PERINATAL
TRANSMISSION DUE TO SYSTEMIC
ANTIRETROVIRAL DRUG LEVELS IN
NEONATE AT TIME OF DELIVERY
43. IV ZIDOVUDINE
• ZDV READILY CROSSES PLACENTA
• INITIAL IV DOSE RESULTS IN
VIRUCIDAL LEVELS IN MOM &
INFANT
• CONTINUOUS INFUSION ENSURES
STABLE DRUG LEVELS IN INFANT
DURING BIRTH
44. ORAL ZIDOVUDINE
• IF IV ZDV NOT AVAILABLE, ORAL ZDV
MAY BE USED INTRAPARTUM
• ZDV 600MG PO @ ONSET OF LABOR
• 300MG PO Q3H IN LABOR
45. BANGKOK, LANCET 1999
• RANDOMIZED PLACEBO
CONTROLLED
• ZDV 300MG PO BID FROM 36WKS GA
UNTIL ONSET OF LABOR
• 300MG PO Q3H WHILE IN LABOR
• ALL WOMEN ADVISED NOT TO
BREASTFEED
• TRANSMISSION RATES: 9.4% IN RX
GROUP; 18.9% IN CONTROL GROUP
46. ABIDJAN, LANCET 1999
• SIMILAR TRIAL TO BANGKOK, BUT IN
BREASTFEEDING WOMEN
6 MONTHS 4.5 YEARS
ZDV 16.5% 21%
PLACEBO 26.1% 31%
EFFICACY 37% 30%
47. COTE D’IVOIRE & BURKINA
FASO, LANCET 1999
• PLACEBO VS ZDV STARTED @ 36-38
WKS GA
• 300MG PO DAILY
• 600MG PO AT ONSET OF LABOR
• 300MG PO BID UNTIL 7 DAYS PP
• >85% OF INFANTS BREASTFED
>3MOS
• 18% VS 27.5 % TRANSMISSION @
6MOS (38% EFFICACY)
48. • RESULTS SHOW SHORT-COURSE
PO ZDV SAFE & EFFECTIVE IN ING
RISK OF MOTHER-TO-CHILD
TRANSMISSION
• PREVENTION RATES NOT AS HIGH
AS WITH IV ZDV
50. HIVNET 012 STUDY
GUAY ET AL - 1999
• 13626 RANDOMIZED - NVP VS ZDV
• NVP REGIMEN
• 200MG PO AT ONSET OF LABOR
• 2MG/KG PO DOSE TO BABY 72HR
DEL’Y
• ZDV REGIMEN
• 600MG PO AT ONSET OF LABOR
• 300MG PO Q3H DURING LABOR
• 4MG/KG BID x7 DAYS TO INFANTS
52. SO WHAT?
• EFFICACY OF SHORT-COURSE NVP
47% GREATER THAN SHORT
COURSE ZDV
• CURRENTLY SHORT-COURSE PO
NVP NOT COMPARED TO IV ZDV
FOR TRANSMISSION PREVENTION
53. CONCLUSIONS
• DURING LABOR - ZDV 2MG/KG IV
LOADING DOSE, THEN 1MG/KG/HR
• IF IV ZDV NOT AVAILABLE CONSIDER
PO REGIMEN
• MAY CONSIDER ADDITION OF
NVP 200MG PO TO IV ZDV @ ONSET
OF LABOR
55. OBSTETRICAL PRACTICE
• 70 % OF HIV TRANSMISSION
OCCURS INTRAPARTUM.
• THE GOAL OF OBSTETRICAL
MANAGEMENT OF THE HIV PATIENT
IS TO AVOID THOSE PRACTICES
THAT INCREASE RISK OF
TRANSMISSION.
56. OBSTETRICAL PRACTICE
RUPTURE OF MEMBRANES
LANDESMAN ET AL., 1996
• RUPTURED MEMBRANES ONE OF
MANY VARIABLES EXAMINED
• 281 MOTHER-CHILD PAIRS WITH
MEMBRANES RUPTURED LESS
THAN 4 HOURS
• 206 MOTHER-CHILD PAIRS WITH
MEMBRANES RUPTURED MORE
THAN 4 HOURS
58. OBSTETRICAL PRACTICE
MODE OF DELIVERY - VAGINAL
• ARTIFICIAL RUPTURE OF MEMBRANES
SHOULD BE AVOIDED
• RUPTURE OF MEMBRANES PAST 4
HOURS SHOULD BE AVOIDED
• FETAL SCALP SAMPLING AND THE USE
OF SCALP ELECTRODES SHOULD BE
AVOIDED
59. MODE OF DELIVERY:
EUROPEAN MODE OF DELIVERY
COLLABORATION – MARCH, 1999
• RANDOMIZED CLINICAL TRIAL
• 370 MOTHER-CHILD PAIRS
ANALYZED
• 203 DELIVERED BY C-S
• 167 DELIVERED VAGINALLY
60. MODE OF DELIVERY:
EUROPEAN MODE OF DELIVERY
COLLABORATION – MARCH, 1999
0
2
4
6
8
10
12
% INFANTS INFECTED
C-S
Vag.
61. MODE OF DELIVERY:
EUROPEAN MODE OF DELIVERY
COLLABORATION – MARCH, 1999
• 203 C-S PERFORMED
• 165 WERE PERFORMED
ELECTIVELY
• 31 WERE PERFORMED
EMERGENTLY
62. MODE OF DELIVERY:
EUROPEAN MODE OF DELIVERY
COLLABORATION – MARCH, 1999
0
1
2
3
4
5
6
7
8
9
% Infected Infants
Elective
Emergency
63. MODE OF DELIVERY: META-ANALYSIS
THE INTERNATIONAL PERINATAL HIV
GROUP, APRIL 1999
• 15 PROSPECTIVE COHORT STUDIES
• 8533 MOTHER-CHILD PAIRS
• REDUCTION OF TRANSMISSION 50% (OR
0.43, 95% CI, 0.33 – 0.56) WITH ELECTIVE
C-S VS. OTHER MODES OF DELIVERY
• REDUCTION OF TRANSMISSION 87% (OR
0.13, 95% CI, 0.09 – 0.19) WITH ELECTIVE
C-S & PACTG 076
64. MODE OF DELIVERY – CAESAREAN
SECTION
• HIV INFECTED WOMEN SHOULD BE
COUNSELLED ABOUT ELECTIVE C-S
• VERTICAL TRANSMISSION IS REDUCED TO 2%
WITH PACTG 076 THERAPY AND ELECTIVE C-S
• WOMEN WITH HIGH VIRAL LOADS MAY BENEFIT
MOST FROM C-S
• TO AVOID SROM & ONSET OF LABOUR, ELECTIVE
C-S IS PERFORMED AT 38 WEEKS
• AFTER SROM OR ONSET OF LABOUR C-S IS
LESS PROTECTIVE
• TO AVOID C-S MORBIDITY, ANTIBIOTIC
PROPHYLAXIS SHOULD BE CONSIDERED
66. HIV IN PREGNANCY – VIRAL LOAD
WOMEN AND INFANTS TRANSMISSION STUDY (WITS): GARCIA ET
AL., 1999
26 of 64
Greater than
100,000
17 of 54
50,001 – 100,000
39 of 183
10,001 – 50,000
32 of 193
1,000 – 10,000
0 of 57
Less than 1,000
Number of HIV
Transmissions
HIV Viral Load
(Copies per mL)
67. HIV IN PREGNANCY – VIRAL LOAD
WOMEN AND INFANTS TRANSMISSION STUDY (WITS): GARCIA ET
AL., 1999
0
5
10
15
20
25
30
35
40
45
% INFANTS INFECTED
less than 1,000
1,001-10,000
10,001-50,000
50,001-100,000
more than 100,000
69. INTRODUCTION
• HIV DNA PRESENT IN BREAST MILK
• HIV TRANSMISSION CAN OCCUR
THROUGH BREASTFEEDING
• BREASTFEEDING IS AN
INDEPENDENT RISK FACTOR FOR
HIV TRANSMISSION
70. EVIDENCE TO SUPPORT
TRANSMISSION
• ISOLATION OF HIV-1 FROM
CELLULAR & NON-CELLULAR
FRACTIONS OF BREAST MILK
• CASE REPORTS OF INFECTED
CHILDREN BREASTFED BY
MOTHERS WHO ACQUIRED HIV
POSTPARTUM
71. EVIDENCE TO SUPPORT
TRANSMISSION
• DOCUMENTATION OF OTHER
RETROVIRUSES TRANSMITTED
THROUGH BREAST MILK
• CASE REPORTS OF BREAST FED
CHILDREN WHO WERE INITIALLY
HIV NEGATIVE BUT SEROCONVERTED
DURING BREASTFEEDING
72. POLICIES
• AVOIDANCE OF BREASTFEEDING IS
CONTROVERSIAL AND DEPENDS ON
INTERNAL MILIEU
• DEVELOPING COUNTRIES VS
INDUSTRIALIZED COUNTRIES
73. POLICIES
• UNAIDS REVISED STATEMENT 1998:
WOMEN SHOULD BE OFFERED HIV
COUNSELING AND TESTING, BE
INFORMED OF RISKS AND BENEFITS
OF BREASTFEEDING IF THE
MOTHER IS HIV POSITIVE, AND
SHOULD MAKE A DECISION THAT
TAKES INTO ACCOUNT THE
INDIVIDUAL &FAMILY SITUATIONS
74. MECHANISM OF
TRANSMISSION
• EXACT MECHANISM OF
TRANSMISSION THROUGH BREAST
MILK STILL NOT WELL
UNDERSTOOD
• INFECTION VIA CELL-FREE HIV IN
BREAST MILK OR VIA HIV-INFECTED
CELLS
• SUSCEPTIBILITY OF IMMATURE
NEONATAL GI TRACT TO VIRUS
• GI TRACT MUCOSAL DAMAGE
76. MALAWI, JAMA 1999
• CUMULATIVE INFECTION RISK
WHILE BREASTFEEDING
• 3.5% AT END OF 5 MONTHS
• 7.0% AT END OF 11 MONTHS
• 8.9% AT END OF 17 MONTHS
• 10.3% AT END OF 23 MONTHS
• NO FURTHER TRANSMISSION AFTER
BREASTFEEDING STOPPED
77. MULTICENTER STUDY,
LANCET 1998
• CUMULATIVE INFECTION RISK
WHILE BREASTFEEDING
• 0.7% AT END OF 6 MONTHS
• 0.95% AT END OF 9 MONTHS
• 2.5% AT END OF 12 MONTHS
• 6.3% AT END OF 18 MONTHS
• 7.4% AT END OF 24 MONTHS
• 9.2% AT END OF 36 MONTHS
78. DURATION OF
BREASTFEEDING
• ? EARLY WEANING POLICY
• PROBLEMS WITH EARLY WEANING
• ADVERSE NEONATAL EFFECTS
• COLOSTRUM HIGHLY INFECTIOUS
79. EXCLUSIVITY OF
BRESTFEEDING
• STUDIES - INFANTS EXCLUSIVELY
BREAST FED AT LOWER RISK OF
ACQUIRING HIV THAN THOSE FED
WITH OTHER TYPES OF MILK, TEA,
OR JUICE WHILE BEING BREAST
FED
80. BRAZIL STUDY, 1998
• CHILDREN FED WITH OTHER TYPES
OF MILK WHILE BEING BREASTFED
WERE AT 2.2-FOLD GREATER RISK
OF HIV INFECTION THAN THOSE
EXCLUSIVELY BREASTFED
• CHILDREN FED WITH TEA OR FRUIT
JUICE WHLE BEING BREASTFED
WERE AT 2.6-FOLD GREATER RISK
OF INFECTION
81. DURBAN (SOUTH AFRICA),
LANCET 1999
• 3 GROUPS OF CHILDREN - NEVER
BREASTFED, EXCLUSIVELY
BREASTFED, MIXED FEEDING
• NO SIGNIFICANT DIFFERENCE IN
TRANSMISSION BETWEEN NEVER
AND EXCLUSIVELY BREASTFED
GROUPS
• SIGNIFICANTLY INCREASED RISK
OF TRANSMISSION FOR MIXED
84. CONCLUSION
• PRECISE RISK FACTORS AND
MECHANISM OF TRANSMISSION
STILL NOT WELL UNDERSTOOD
• WOMEN WHO ARE HIV POSITIVE
SHOULD BE ADVISED TO AVOID
BREASTFEEDING
• WOMEN WHO BREASTFEED
SHOULD BE INFORMED THAT
TRANSMISSION CAN OCCUR
86. HIV SCREENING
• ALL PREGNANT WOMEN SHOULD
BE OFFERRED HIV TESTING
• PRE- & POST- TEST COUNSELING
FOR ALL PREGNANT WOMEN
• TARGETED TESTING OF PREGNANT
WOMEN WHO REPORT HIGH RISK
BEHAVIOR NOT RECOMMENDED
87. ANTENATAL CARE
• HIV IN PREGNANCY REQUIRES
MULTIDISCIPLINARY APPROACH
• ANTENATAL CARE IS SIMILAR TO THAT OF
HIV -VE WOMEN
• PREGNANCY NOT HIGH RISK
• AVOID INVASIVE PROCEDURES
• MONITOR CD4+ AND VIRAL LOAD AT
LEAST EVERY 3 MONTHS IF ABLE TO
PROVIDE ANTIRETROVIRAL THERAPY
88. ANTIRETROVIRAL USE
• Zidovudine reduces perinatal
transmission in women at different
stages of disease
• long (ante, peri, and postnatal) as well
as shorter regimens effective
• still effective in breastfeeding
populations
• Use of other antiretrovirals in
combination with ZDV promising, still
investigational
89. INTRAPARTUM
ANTIRETROVIRAL
THERAPY
• DURING LABOR - ZDV 2MG/KG IV
LOADING DOSE, THEN 1MG/KG/HR
• IF IV ZDV NOT AVAILABLE CONSIDER
PO REGIMEN
• MAY CONSIDER ADDITION OF
NVP 200MG PO TO IV ZDV @ ONSET
OF LABOR
90. BREASTFEEDING
• PRECISE RISK FACTORS AND
MECHANISM OF TRANSMISSION
STILL NOT WELL UNDERSTOOD
• WOMEN WHO ARE HIV POSITIVE
SHOULD BE ADVISED TO AVOID
BREASTFEEDING
• WOMEN WHO BREASTFEED
SHOULD BE INFORMED THAT
TRANSMISSION CAN OCCUR