This document summarizes information about HIV, hepatitis B, and hepatitis C as they relate to pregnancy. It discusses transmission routes, screening recommendations, clinical features, and management approaches for each virus. The key points are that screening allows for interventions to reduce mother-to-child transmission of HIV and hepatitis B, and treatment involves antiretroviral therapy for HIV and immunoglobulin plus vaccination for hepatitis B. Mode of delivery generally does not impact transmission risk, and breastfeeding is not recommended for HIV but is safe for hepatitis B and C.

1. human immunodeficiency
virus
(HIV)
by
Dr.Tarig Mahmoud Ahmed
MD SUDAN
HAIL UNIVERSITY KSA

2. The HIV virus is an RNA retrovirus

3. Transmission
 Horizontal: transmitted through sexual
contact, blood and blood products
 Vertical (mother-to-child).
 Peri natal: occurs in the late third
trimester, during labour or delivery ---80%
 breastfeeding --28%
 Most of the pregnant women with HIV have
acquired their infection through
heterosexual exposure.

4. Screening
 Routine antenatal screening has increased
detection rates and new treatments have
increased life expectancy.
 all pregnant women should be offered
screening in pregnancy because antenatal
interventions can reduce maternal-to-child
transmission of HIV infection from 25 to
30% to less than 2 %.

5. counselling
 Ensure that the woman understands the
reasons for screening.
 Appropriate interventions would be of
benefit to her baby.
 Reassured about confidentiality and
support,
If she be positive.
 Disclosure of the HIV diagnosis to her
partner should be handled with sensitivity.

6. Clinical features
 Infection with HIV begins with an
asymptomatic stage with gradual
compromise of immune function eventually
leading to acquired immunodeficiency
syndrome (AIDS).
 The time between HIV infection and
development of AIDS ranges from a few
months to as long as 17 years in untreated
patients.

7. Factors Increased risk of transmission to
child
 Advanced maternal HIV disease.
 High maternal plasma viral load.
 Low CD4 lymphocyte counts.
 Prolonged rupture of membranes.
 Chorioamnionitis.
 Preterm delivery.
 Obstetric interventions such as FBS or fetal
scalp electrodes.
 Coexisting viral infections e.g. herpes and
hepatitis C.
 Breastfeeding doubles transmission rate.

8. Management
Interventions to reduce the risk of HIV
transmission are:
 Low or undetectable viral counts at time
of delivery.
 Anti-retroviral therapy, given antenatally
and intrapartum to the mother and to the
neonate for the first 4–6 weeks of life.
 Delivery by elective Caesarean section.
 Avoidance of breastfeeding.

9.  Women who do not require HIV treatment
for their own health require antiretroviral
therapy to prevent mother-to-child
transmission usually commenced between 28
and 32 weeks of gestation and should be
continued intrapartum.

10.  Lactic acidosis is a recognized complication
of highly active antiretroviral therapy
(HAART) regimens and may mimic the
symptoms and signs of pre-eclampsia.
 Where this condition is suspected, liver
function tests and blood lactate should be
monitored.

11. Mode of delivery
 An elective vaginal delivery is an option for
women taking triple drug antiretroviral
therapy who have a viral load below 50
copies/mL at the time of delivery.
 Women who planned for vaginal delivery
should have their membranes left intact for
as long as possible.
 Use of fetal scalp electrodes and fetal blood
sampling should be avoided.

12. Caesarean section
 A Caesarean delivery is recommended if a
woman is taking monotherapy, or if viral load
is above 50 copies/mL at the time of delivery.
 A Caesarean delivery should be recommended
for women with hepatitis C co infection as the
risk of transmission is higher.

13. Management of infants
 Cord should be clamped as early as possible
after delivery and the baby should be bathed
immediately after the birth.
 NO breast feeding.
 All infants born to women who are HIV
positive should be treated with antiretroviral
therapy from birth for 4–6 weeks.
 PCR is used for the diagnosis of infant
infection, typically, tests are carried out at
birth, then at 3 weeks, 6 weeks and six months.

14. Hepatitis B

15. The hepatitis B virus (HBV) is a DNA virus

16. Transmission
Transmitted:
 mainly in blood
 other body fluids such as saliva, semen and
vaginal fluid.

17. Lab results
The presence of antibodies to the hepatitis B
surface antigen represents immunity
resulting either from previous infection or
from immunization and should not cause
concern
The presence of the surface antigen itself, or
the ‘e’ antigen, represents either a recent
infection(HbeAg) or carrier status(HbsAg).

18. Screening
 screening for HBV should be offered to all
pregnant women so that effective post-natal
intervention can be offered to infected
women to decrease the risk of mother-to-
child transmission.
 85 % of babies born to mothers who are
positive for the hepatitis e antigen (HBeAg)
will become HBsAg carriers and
subsequently become chronic carriers,
compared with 31% of babies who are born to
mothers who are HBeAg negative.

19.  Mother-to-child transmission of the HBV is
approximately 95 % cent preventable through
administration of vaccine and
immunoglobulin to the baby at birth.

20. Clinical features
 Hepatitis B is a virus that infects the liver,
but many people with hepatitis B viral
infection have no symptoms.
 The HBV has an incubation period of 6 weeks
to six months.

21. Management
 Women who screen positive for hepatitis B
should be referred to a hepatologist .
 To prevent vertical transmission of
hepatitis B, a combination of hepatitis B
immunoglobulin and hepatitis B vaccine
may be given.

22.  The passive immunoglobulin provides
immediate protection against any virus
transmitted to the baby from contact with
blood during delivery,
 The active vaccine provides ongoing protection
from subsequent exposure in the household.
 The active vaccine is given in three doses: at
birth, at one month and at six months of age.

23. Mode of delivery
 Mode of delivery does not appear to have a
significant effect on vertical transmission
 Manage delivery to minimize risk of vertical
transmission by avoiding fetal blood sampling
and fetal scalp electrodes where possible.
 Breastfeeding is not a risk factor for mother-
to-child transmission of hepatitis B virus.

24. Hepatitis C

25. Hepatitis C is a RNA virus

26. Transmission
 Transmitted through infected blood
products and injection of drugs.
 It can also occur with tattooing and body
piercing.
 Mother-to-child transmission can occur
due to contact with infected maternal blood
around the time of delivery, and the risk is
higher in those co infected with HIV.
 Sexual transmission is extremely rare.

27. Screening
 Current recommendations are that
pregnant women should NOT be offered
routine screening for HCV, because there is
a lack of evidence-based effective
interventions for the treatment of HCV in
pregnancy, and a lack of evidence about
which interventions reduce vertical
transmission of HCV from mother to child.

28. Clinical features
 It is one of the major causes of liver
cirrhosis, hepatocellular carcinoma and
liver failure. Following initial infection,
only 20% of women will have hepatic
symptoms, 80% being asymptomatic.
 The majority of pregnant women with
hepatitis C will not have reached the phase
of having the chronic disease, and may be
unaware that they are infected.

29. Management
 Testing for HCV involves detection of anti-
HCV antibodies in serum with subsequent
confirmatory testing by PCR for the virus, if
a positive result is obtained.
 Upon confirmation of a positive test, a
woman should be offered post-test
counselling and referral to a hepatologist
for management and treatment of her
infection.

30.  In non-pregnant adults, interferon and
ribavirin can be used to treat hepatitis C
infection, but these are contraindicated in
pregnancy.

31. mode of delivery
 There is no strong evidence regarding mode
of delivery in women with hepatitis C.
 elective Caesarean section NOT
recommended for all women with hepatitis C,
although it is recommended if the woman is
also HIV positive.
 Breastfeeding is not a risk factor for mother-
to-child transmission of hepatitis c virus.

32. Thank you for your attention