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1. HIV IN PREGNANCY
BY: DR. K.S.K JUSU
DEPARTMENT OF O&G
SCHOOL OF CLINICAL SCIENCES
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2. OUTLINE
• Introduction
• Epidemiology
• Risks factors for mother to child transmission
of HIV
• Clinical features of HIV
• Screening of pregnant women for HIV
• Management of HIV in pregnant women and i
nfants.
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3. OUTLINE
• Introduction
• Epidemiology
• Risks factors for mother to child transmission
of HIV
• Clinical features of HIV
• Screening of pregnant women for HIV
• Management of HIV in pregnant women and i
nfants.
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4. Introduction
• The HIV virus is an RNA retro virus transmitted
through sexual contact, blood and bood produ
cts transfusion, shared niddles for intravenous
drug users and vertical transmission (mother t
o child )
• The mother to child transmission (MTCT) can
occur during
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5. Pregnancy (in the late trimester )
Labour and delivery
Breastfeeding,
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6. Epidemiology
• In the absence of interventions, the risk of ver
tical transmission of HIV is as high as 25 to 30
percent.
• Over 90 percent of HIV infection in children un
der 15yrs are due to MTCT. transmission is hi
ghest during pregnancy followed by labor and
delivery and then breast-feeding.
• Delayed institution of PMTCT measures result
s in a higher risk of transmission.
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7. Epidemiology cont..
• With the implementation of HIV testing, coun
seling, antiretroviral medications, delivery by
cesarean section and discouraging breast-feed
ing, the MTCT can be decreased to less than 2
percent.
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8. Risk factors for mother to child transm
ission of HIV
• Advanced maternal disease
• PROM
• chorioamnionitis
• Preterm delivery
• Obstetrics interventions eg Amniocentesis
• Infections eg STIs, malaria
• Malnutrition
• Breast-feeding
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9. • Prolonged labor,instrumental delivery & episi
otomy
• Coexisting viral infections eg herpes and hepat
itis C
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10. Clinical features
• Infection with HIV begins with an asymptomat
ic stage with gradual compromised of the imm
une functions eventually leading to AIDS.
• The time between HIV infection and the devel
opment of AIDS ranges from months to as lon
g as 17yrs in untreated patients.
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11. Screening of pregnant women for HIV
• All pregnant women should have their serosta
tus evacuated when they first presented for a
ntenatal care
• The health care worker should ensure that the
woman understand the reasons for the screen
ing.
• Confidentially and support should be assured.
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12. Different screening tests
ELISA
Most common screening test. It looks for t
he presence of antibodies
WESTERN BLOT
specific viral proteins are separated by electrop
horesis and a reaction of an antibody to three
proteins must occur for the test to be consider
ed positive.
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13. Blood and viral count
It is used to access the HIV status of the pregna
nt women
Hepatitis screening (hepatitis B&C)
Tuberculosis testing
Other sexually transmitted diseases screening
eg syphilis,
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14. Management of HIV in pregnant wom
en
• The following interventions if implemented ca
n reduce vertical transmission to less than 2%
①Antiretroviral therapy
①Delivery by cesarean section
①Avoidance of breast-feeding
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15. Antiretroviral therapy
• All women who have HIV should be advised to
take antiretroviral therapy during pregnancy a
nd at delivery.
• The choice of treatment and gestational age a
t which it is commenced will depend on wheth
er the woman needs treatment for her own h
ealth or simply to prevent vertical transmissio
n
• It also depends on the viral load.
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16. • If the mother is taking the antiretroviral to pre
vent MTCT, it is usually started at between 28-
32weeks and should be continued intrapartu
m.
• Combination antiretroviral should be offered i
n all cases and Zidovudine should always be p
art of this HAART
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17. • The antiretroviral drugs used in pregnancy fall
into three broad categories
1.NRTIs
2.NNRTs
3.PIs
Combination regimen usually including 2NRTIs
with either an NNRTIs or one or more proteas
e inhibitors are recommended.
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18. • NOTE:
• NRTIs cross the placenta but are well tolerate
d during pregnancy
• NNRTIs ( Nevirapine & Efavirenz) cross the pla
centa but Efavirenz is not recommended in th
e first trimester because of reported cases of
neural tube defects.
• PIs do not cross the placenta easily no teratog
enic effects have been reported.
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19. • If a woman is taking combination antiretrovira
l and her viral load is <50copies/ml at the time
of delivery, an elective vaginal delivery can be
done.
• If her viral load is >50copies/ml or has been ta
king ZDV monotherapy then cesarean delivery
is recommended.
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20. Ceserian Delivery
• Ceserian Delivery before the onset of labor m
ay prevent micro transfusion that occurs with
uterine contractions.
• Also avoiding vaginal delivery eliminates expo
sure to virus in cervicovirginal secretions and
blood at the time of delivery.
• The option of elective cesarean delivery shoul
d be discussed to all pregnant women with HI
V at 38 weeks of gestation. The
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21. • A cesarean delivery should be recommended f
or all women with hepatitis C confection as th
e risk of transmission is higher.
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22. •
Thanks
for
your
undivid
ed
attention.
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