INTRODUCTION STRUCTURE MODES OF TRANSMISSION HEP B IN PREGNANCY HIV IN PREGNANCY

1. Topic :- HIV AND PREGNANCY update (2020)
Dr Rahul JainDr Sharda Jain
for Gynaecologist & Surgery Specialist

2. Over 400 ppts are available on
slideshare.net ***for use of public/Doctors
www.slideshare.net / Lifecarecentre

3. CONTENTS-
• INTRODUCTION
• STRUCTURE
• MODES OF TRANSMISSION
• HEP B IN PREGNANCY
• HIV IN PREGNANCY

4. INTRODUCTION
• HIV=HUMAN IMMUNODEFICIENCY VIRUS
• AIDS=ACQUIRED IMMUNODEFICIENCY SYNDROME
• AIDS IS DEFINED AS CLINICAL DIAGNOSIS OF ANY
STAGE 4 CONDITION OR CD4 CELL
COUNT<200/MM3 WITH CONFIRMED HIV
INFECTION.

5. STRUCTURE-

6. MODES OF TRANSMISSION
• SEXUAL TRANSMISSION
• BLOOD TRANSFUSION
• IV DRUG ABUSERS
• NEEDLE STICK EXPOSURE
• MUCOUS MEMBRANE SPLASH
• PERINATAL TRANSMISSION
1. PLACENTAL SPREAD(TRAUMA)
2. INTRAPARTUM SPREAD(VAGINAL DELIVERY)
3. PROLONGED RUPTURE OF MEMBRANES
4. BREASTFEEEDING

7. ROUTES BY WHICH HIV NOT
TRANSMITTED
• CLOSE PERSONAL CONTACT(HUGGING)
• SHARING OF UTENSILS AND INSECT BITES
• CONTACT IN SWIMMING POOL

8. LIFE CYCLE-

9. HIV CLINICAL STAGING
• VIRAL TRANSMISSION>ACUTE RETROVIRAL(2
WEEKS) SYNDROME>
• SEROCONVERSION(4 WEEKS)>
• ASYMPTOMATIC CHRONIC PHASE(8YRS)>
• SYMPTOMATIC HIV INFECTION(10-12YRS)
• NORMAL CD4 COUNT=50-1200/MM3
• TYPICALLY HIV INFECTED INDIVIDUAL DROP ~50
CELLS/YR

10. AIDS DEFINING ILLNESS-
OTHERS-CANDIDIASIS,HERPES,KAPOSI
SARCOMA,LYMPHOMA,TOXOPLASMOSIS,WASTING

11. OTHER IMPORTANT SIGNS-
• WHEN TO SUSPECT HIV?
• PERSISTENT GENERALIZED LYMPHADENOPATHY
• HERPES PATIENTS
• TB PATIENTS
• UNEXPLAINED WEIGHT LOSS
• ORAL LEUKOPLAKIA

12. INVESTIGATION-
• WESTERN BLOT ASSAY-MOST CONFIRMATORY
TEST
• IgG to ENVELOPE PROTEINS=ELISA
• REVERSE TRANSCRIPTASE –PCR
• DNA-PCR FR ESTIMATING VIRAL LOAD

14. TREATMENT-
• DRUGS-
• INHIBHITORS OF REVERSE TRANSCRIPTASE
1. NRTI’S(NUCLEOSIDE)-ZIDOVUDINE,LAMIVUDINE
2. NUCLEOTIDE RTI’S-TENOFOVIR
3. NON NUCLEOSIDE RTI’S-NEVIRAPINE,EFAVIRENZ
• PROTEASE INHIBHITOR-
INDINAVIR,LOPINAVIR/RITONAVIR,NELFINAVIR
• INTEGRASE INHIBHITORS-RALTEGRAVIR
• FUSION INHIBHITORS-ENFUVIRITIDE
• CCR5 ANTAGONIST-MARAVIROC

15. MECHANISM-

16. STRATEGY-
• START PATIENT ON THERAPY WITH 3 NRTI’S
• 1 PI+2 NRTI’S
• 1NNRTI+2NRTI’S
• ALL DRUGS ARE STARTED SIMULATNEOUSLY AT FULL
DOSE
• IMMUNE RECONSTITUTION SYNDROME
• EFAVIRENZ CAN BE SAFELY GIVEN IN PREGNANCY
EXCEPT 1ST TRIMESTER.
• TENOFOVIR AND LAMIVUDINE PREFERRED FOR
HIV+HEP B,HIV+TB,PREGNANCY
• PREFERRED FIRST LINE-
TENOFOVIR/ZIDOVUDINE+LAMIVUDINE+EFAVIRENZ

17. HIV IN PREGNANCY-
• ROUTINE SCREENING FOR ALL ANTENATAL WOMEN
• ELECTIVE CAESAREAN SECTION AT 38 WEEKS
• PERIPARTUM BROAD SPECTRUM ANTIBIOTICS
AND ZIDOVUDINE IV INFUSION 4 HRS BEFORE
CAESAREAN(2MG/KG/HR,MAINTENANCE DOSE
1MG/KG/HR)
• SAFETY OF SURGEON(DOUBLE COVERS)

18. HIV IN PREGNANCY-
• ZIDOVUDINE MONOTHERAPY TO BE STARTED FOR
NEONATE( 2MG/KG IS GIVEN 4 TIMES A DAY)
• BREASTFEEDING IS C/I WHEN AFASS CRITERIA
MATCHES(AFFORDABLE,FEASIBLE,ACCEPTABLE,
SUSTAINABLE,SAFE)
• CONTRACEPTION-IUCD ARE SAFER,AND CONDOM
USE SHOULD BE CONTINUED.

19. HEPATITIS AND PREGNANCY
• HEPATITIS B IS M/C VIRAL HEPATITIS IN
PREGNANCY
• HEPATITIS E IN PREGNANCY ASSOCIATED WITH
HIGHEST MORTALITY
• HEPATITIS ASSOCIATED WITH-
• GDM
• LOWER APGAR SCORES
• PRETERM DELIVERY
• DX-AST,ALT~2000IU/L,S BILIRUBN-5-20MG/DL

20. HEPATITIS TREATMET
• HOSPITALIZATION
• SMALL HIGH CALORIE FEEDS,LOW PROTEIN
DIET,LOW FAT DIET,
• VIT K(IF PT PROLONGED)
• IV FLUIDS,ELECTROLYTES,
• ANTI EMETICS,
• PAIN MANAGEMENT

21. HEPATITIS AND PREGNANCY
• HEP E SEROLOGY-IgM HEV
• IF A BABY IS BORN TO HEP B + MOTHER THEN
1. HB Ig-0.5ml I.M. IS GIVEN SOON AFTER BIRTH
2. START Hep B VACCINE 1ST DOSE GIVEN WITH IN 12
HRS